HEALTHbeatISSN 0118 4253 The Official Publication of the DEPARTMENT OF HEALTH Issue No. 82 May - June 2014

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contents 5 Six Months After Typhoon Yolanda 5 Yolanda Child Survivors Want Active Roles 6 in Disaster Planning – intl group Are Promises Made to be Broken? 8 Renewing the Promise for Kalusugan Pangkalahatan 10 “We Are Not Letting Mothers Die.” 12 DOH Files Is Out 13 Introducing the Hospital Accreditation Committee 14 Zero Tolerance For Drunk and/or Drugged Driving 16 Dissecting IRR on Drunk/Drugged Driving 17 Cover story: MERSCoV On The Loose 19 24 33 MERSCoV from a Muslim perspective 22 Philippine Health Secretary Addresses 24 The World Health Assembly The Link Between Climate & Health 25 PH Hosts 4th ASEAN Dengue Day 27 Philippines, Rabies-Free by 2020? 28 On World No Tobacco Day, WHO Calls For Gov’ts. 30 To Raise Tobacco Taxes 43 Sin Tax Law Effective in Reducing 32 Smoking Prevalence Among the Youth and Poor Anthony R. Roda story 33 DOH Celebrates Babae, Mahalaga Ka! 37 120-bed Ospital ng Parañaque Inaugurated 39 Free Men’s Health Check 40 In DOH Hospitals For Fathers’ Day Column: Prostate Cancer: The Scourge of Fathers 41 Ectodermal dysplasia 43 Health & Social Media in the Philippines 47 49 Feed the Children in Malabon and Manila 49 38 KALAbeat 46 laughter HEALS jokes n'yo 51 SAbeat DEPARTMENT OF HEALTH - Health Promotion and Communication Service (formerly National Center for Health Promotion) 2F Bldg. 18, San Lazaro Compound, Sta. Cruz, Manila 1003, Philippines I Tel. No. (63-2) 743-8438 HEALTHbeat Website: www.healthbeat.com I Facebook: www.facebook.com/DOH.HEALTHbeat.ph I Email: [email protected]

A HealthBeat tradition ends, or, this is goodbye, Tony.

Goodbye. This was a constant greeting on his lips, when it started nobody was sure, was it this year? Tony invariably greeted his officemates and friends with a ‘Goodbye’ to the sound of “Good morning!”

Tony was the heart and soul of HealthBeat. From its inception to its camera-ready form, Tony had a hand. Actually, he was a one-man band orchestrating everything that went into this magazine. Especially the jokes. Editorial Board Ivanhoe C. Escartin, MD He was the creative one, always thinking of putting out something, from the newsletter type Rosemarie G. Aguirre internal publication “PIHES-ta” (of the erstwhile Public Information & Health Education Service Chief Editors Anthony R. Roda of the Department of Health or DOH) where it metamorphosed into the HealthBeat (the official May Elenor R. de Guzman publication of the DOH) that we know today. Managing Editor Donato Dennis B. Magat

With Tony absent, HealthBeat will never be the same again. Staff Writers Elizabeth G. Mascareňas Glen S. Ramos Speaking of changes, we revisit the people affected by Yolanda six months after the devastation Abigail Corpuz-Quetulio and see from different perspectives how they are coping after the typhoon. We also review the Photographer Paquito P. Repelente threat that was MERSCoV and how the country with the Health department’s newly designated spokesperson, Dr. Lyndon Lee Suy, addressed this potential public health concern of epic Cover Design Diosdado G. Angeles, Jr. proportions. & Layout Graphics Design Rhoderic N. Domingo The other articles are about topics that have come to our attention recently and we thought you Frederick C. Pereňa might want to know more about it. Contributors Roxan Autine Esstrella, RN Harold James Doroteo, RN Expect more changes as we put out more issues. Another era begins. Clarito U. Cairo, Jr., DPSVI, DPCOM Karen Alparce-Villanueva So, we say a final goodbye to Tony. May you find more bliss in publishing heaven. George Nava True II Circulation DOH-NCHP Production, - The Editors Dissemination & Collection Unit

FOR EDUCATIONAL PURPOSES ONLY. NOT FOR SALE. Opinions expressed in this publication do not necessarily represent those of the DOH. The mention of specific companies or of certain manufacturer’s products does not imply that they are endorsed or recommended by the DOH in preference to others of similar nature. Articles may be reproduced in full or in part without prior permission, provided credit is given to the DOH for original pieces. A copy of the reprinted or adapted version will be appreciated. Articles, artworks, photographs, caricatures, letters and other contributions are most welcome. Materials will be edited for clarity and space. Unsolicited manuscripts will not be returned. Contributors must indicate their names and addresses.

4 HEALTHbeat I May - June 2014 Disaster Health Six months after Typhoon Yolanda, health investment needed

http://www.wpro.who.int/philippines/mediacentre/features/typhoon_yolanda_6months_on_photobook/en/ May, 2014 - The full scale repair and rebuilding of the 582 public health training local health workers in psychological destruction and devastation wrought by facilities that were damaged or destroyed first aid and community based mental health super Typhoon Yolanda was a tragedy that and to provide advice to ensure government care to help address physical and mental affected the lives of millions but now we and aid monies are directed to where the health needs. We are also funding activities can find a way to build a sustainable health need is the greatest." aimed at supporting the thousands of people system for the future." says Dr. Julie Hall, "We need clean and safe health disabled as a result of injuries caused by the WHO Country Representative. facilities for the 70,000 births expected Typhoon." As the nation marked six in the next three months as well as for "Six months on, we have made real months since the Philippines worst ever those individuals who have ongoing health progress, but the resilience of the Filipino natural disaster, communities are slowly complications from diseases such as diabetes, spirit alone will not be enough. Ensuring rebuilding their lives. cancer and tuberculosis," Dr. Hall stated. the resilience of the health infrastructure, "The WHO in support of the The WHO is working in communities universal health care for all Filipinos, and Department of Health, have moved from to prevent disease outbreaks through health continued investments in health promotion the initial emergency phase which focused and hygiene promotion and ensuring are all required." on coordinating the arrival and dispersal families have access to, and use, clean water "The country needs a healthy of more than 150 foreign medical teams, for drinking and washing. population to sustain its successful economic coordination of emergency health services "Six months after the event, we development,” said Dr. Hall. “The chance and supplies, and prevention of disease are seeing the emergence of mental health to make a sound investment for the future outbreaks to addressing the longer term problems in communities with people bystrengthening health systems and health issues facing communities," said coming to terms with the enormity of infrastructure is now. We need to continue Dr. Hall. their loss, whether of loved ones, homes or to place health at the heart of all healing.” "WHO continues to map the state of livelihoods," said Dr. Hall. "The WHO has been (WHO release)

May - June 2014 I HEALTHbeat 5 Disaster Health Yolanda child survivors want active roles in disaster planning – intl group by: IBARRA C. MATEO http://www.gmanetwork.com/news/story/359856/lifestyle/healthandwellness/ yolanda-child-survivors-want-active-roles-in-disaster-planning-intl-group

Children who survived Typhoon maternal, newborn, and child survival in Children, mothers the most vulnerable Yolanda and are still living in the areas countries consistently ranked as the most among survivors devastated by the storm surge want to difficult places to be a mother. play active roles in planning for future It includes an annual “Mothers’ Humanitarian emergencies can emergencies and disasters to help them Index,” which this year surveyed 178 have a profound effect on the mental health better cope in post-crisis situations. countries, and studied in-depth the link of mothers and children. This was among the findings of a between poor performance on the indicators “Abrupt life changes, family study by Save the Children, a leading global and chronic crises, conflict, and the everyday separation, worry about loved ones, and and independent organization for children emergencies faced by mothers and children loss of community and family support are in need, and several non-governmental globally. emotionally difficult for almost everyone organizations (NGOs) that consulted 174 The Philippines landed on the caught up in a crisis,” said the report. children and young people in Yolanda- 105th slot out of 178 countries ranked, down “Children are especially sensitive to stricken areas, specifically asking them what from last year’s 104th. In the Southeast Asian the emotional states of their parents. When was most important to them after surviving region, the Philippines is behind Vietnam, mothers and fathers are struggling to deal the deadly typhoon. Thailand, Malaysia, and Singapore, and just with their own stress, it can impair the ability In the section of the “State of the ahead of Timor-Leste and Indonesia. of their traumatized children to process their World’s Mothers 2014: Saving Mothers and One troubling statistic revealed own feelings,” it added. Children in Humanitarian Crisis” discussing in the report is that in the Philippines, an Dr. Francesca Cuevas, director of the Philippines and Yolanda, the report increasing percentage of deaths of children health of Save the Children-Philippines, said older children want to take classes in under 5 years of age are occurring among said the organization is helping restore the “life skills” such as how to build shelters, newborn babies in the first month of life. delivery of primary and basic health services. environmental science, and fishing. These mostly preventable deaths “Health facilities are still “They want more friendly spaces for are likely to have risen in number following overwhelmed...More than one million people children to share feelings and put their minds Yolanda – and are likely to have affected have no access to basic health services. at ease. And they want adults and authorities newborn girls disproportionately, the report Pregnant women are giving birth without to talk to them about exactly what is going said. access to safe and clean health facilities,” on when a disaster strikes,” the annual report “Worldwide, women and children Cuevas said at a press conference launching added. are much more likely than men to die in a the report. disaster, whether man-made or natural,” it Cuevas added that psycho-social 105th out of 178 countries said. health services to mothers and children There is an urgent need to increase should be given priority because they are the For its 2014 edition, the annual access to healthcare in places where the “most vulnerable and most compromised” “State of the World’s Mothers” report looks government’s capacity is weak and conflict segment of the population affected by at the impact of humanitarian crises on and insecurity is widespread, it added. Yolanda.

6 HEALTHbeat I May - June 2014 BEACON Boxes Everyone has the right to survive He said it must be ensured that the poorest of the poor are not “left completely One way Save the Children is Olney said Filipinos' resiliency unprepared” and that “every child has the trying to improve conditions for pregnant is being tested by more frequent and right to survive, no matter where he or she women and newborns is by the pre- increasingly severe emergencies. is born.” positioning of “BEACON Boxes” in Yolanda- “Save the Children is now moving hit areas. from relief work to the recovery stage. Save the Children is urging the government The BEACON Box, or Birthing Emergency relief is ending, and we are and the civil society to: Essentials And Care Of Newborns Box, adapting our activities to support the contains basic tools and materials necessary rebuilding of people’s homes and livelihoods,” • Ensure that every mother and to help a pregnant woman deliver in a safe Olney said. newborn living in crisis has access to and clean environment and packaged in a Save the Children was one of the high quality health care, storm-proof box. first international agencies to respond Cuevas said the BEACON Boxes will after Yolanda and remains the largest • Build stronger health systems to be prepositioned in the most vulnerable responder in some of the worst affected minimize the damaging effects of barangays in the Yolanda-affected areas, areas. crises on health, where more than 750 births are expected Almost six months after Yolanda every day. wreaked havoc, the agency has helped • Develop national and local The BEACON Box supplies include more than 470,000 children and adults with preparedness plans tailored to plastic sheets, a tarpaulin, soap, sterile cord assistance, including food, water, medicines, respond to the specific needs of ties, sterile blades, clean towels, a birth shelter, and hygiene items. mothers, children, and babies in certificate, and a lamp. The box aims to assist Olney said a “big focus” of their emergencies, and a pregnant woman in “giving birth in a clean group is working to “keep children safe and environment if she cannot get to a health in education.” • Ensure adequate financing and clinic.” “Future disasters are inevitable and coordination to timely respond to Save the Children has allotted because of climate change they are likely to mothers’ and children’s needs in P10 million to place these boxes in the become even more common. The agency’s emergencies. most vulnerable barangays geared toward response is therefore not only supporting helping the most vulnerable pregnant the huge recovery effort, but is also helping — BM, GMA News women. affected communities adapt and prepare for Statistically, more than 100 of those future disasters,” he said. were likely to have involved a potentially life- “Yolanda showed us the threatening complication, Cueva added. importance of helping mothers when vital “We simply must all work harder to services are destroyed or disrupted. It also help communities prepare for disasters and showed us that after the initial emergency protect pregnant women and newborns,” has passed, existing institutions can be said Ned Olney, Philippine country director of rebuilt and aid can get through quickly,” he the Save the Children. added.

May - June 2014 I HEALTHbeat 7 Child Survival ARE PROMISES MADE TO BE BROKEN? by Dennis B. Magat HEALTHbeat Staff

Filipino National Hero Dr. Jose three-pronged strategy. First, Strengthening scaling-up efforts of countries that account Rizal once said that “the youth is the hope evidence-based country action plans: for 30% of all under-five deaths, particularly of Fatherland.” Yes, indeed, for they shall Participating governments must sharpen in South Asia and Sub-Saharan Africa. High- be their country’s future leaders. However, their country action plans to accelerate burden population is the strengthening of since 1990, more than 216 million children progress towards the Millennium health systems to increase coverage among globally have died from preventable diseases Development Goal (MDG) and set a five-year the underserved populations, including rural before reaching their fifth birthday. With this milestones to monitor progress from 2015 to and low-income groups while high-impact development, will there still be hope? Will 2035. solutions require intensifying efforts to there still be leaders left to fill in the gap? Second, Monitoring and reporting: address the five conditions for almost 60% Despite rapid progress in reducing Governments and partners should increase of child deaths- pneumonia, diarrhea, child deaths since 1990, the world still the availability and accessibility of data malaria, pre-term birth complications and has not fulfilled its promise of survival for and analysis on maternal, newborn, and intrapartum-related complications. children. child mortality to encourage stronger Gender equality is investing UNICEF (United Nations Children’s accountability for child survival. Each year, in education for girls and women and Fund) has committed to track down progress UNICEF and partners will release global empowering them to make decisions that for global commitments to children in progress reports to stimulate public dialogue impact their lives. This also promotes women’s support of the Committing to Child and sustain the political commitment to rights, gender equality, and inclusive Survival: A Promise Renewed global child survival. economic growth. Mutual accountability movement. Third, Promoting global is building broad-based political support A Promise Renewed is a communication and social mobilization for for maternal, newborn, and child survival, movement based on shared responsibility for child survival: Governments and partners monitoring progress against a set of common child survival, and is mobilizing and bringing will mobilize broad-based social support for metrics, and encouraging public dialogue on together governments, civil society, private the principle that ‘no child should die from the triumphs and challenges of efforts to sector, and individuals in the cause of ending preventable causes’. By harnessing the power accelerate declines in preventable maternal, preventable child deaths within a generation. of mobile technology, governments and newborn, and child deaths. It also seeks to advance ‘Every Woman Every partners are engaging all citizens, especially Child’ strategy launched by United Nations women and youth, in the search for DECLINING PATTERNS Secretary-General Ban Ki-Moon to improve innovative solutions to maternal, newborn, Despite the swift reduction in the health of women and children through and child survival. under-five deaths, child survival remains action and advocacy to accelerate reductions an urgent concern. In 2012, approximately in preventable maternal, newborn, and child CRITICAL AREAS 6.6 million children died before reaching deaths. Another move towards preventing their fifth birthday, or approximately 18,000 Since its launch just over a year ago, child deaths can be achieved through a deaths every day. And the risk of dying before A Promise Renewed has made strides by concerted action in five critical areas like five years old varies according to where a signing 176 governments to Committing to geography, high-burden populations, high- child was born. Data revealed that under-five Child Survival: A Promise Renewed pledge. impact solutions, gender equality, and mortality rate in Luxembourg is just 2 per Committing to Child Survival: mutual accountability. 1,000 live births compared to Sierra Leone’s A Promise Renewed is anchored on a Geography pertains to the 182 per 1,000 live births.

8 HEALTHbeat I May - June 2014 Since 1990, about 216 million region that has virtually no reduction in the With only a few months to go before children have died before reaching their fifth absolute number of children dying over the the MDG deadline in 2015, now is the time to birthday. This figure is more than the current past 22 years. Its burden of child deaths now step up our efforts to make sure that more total population of Brazil, which is the world’s stands at about 2 million annually, almost children survive past their fifth birthday, and fifth most populous country. equal to its 1990 level. get the chance to realize their full potential At the current rate of death However, all is not lost in the in life. reduction in children below five years old, campaign to reduce child deaths as some UNICEF Philippines Country the world will only be able to meet its MDG of the world’s poorest countries in terms of Representative Lotta Sylwander said that by 2028. This is 13 years after the deadline national income have made the strongest “we need to address all aspects that affect set in 2015 and by that time 35 million more gains in child survival. Seven high-mortality a child’s life and well being”. She added children have died between 2015 and 2028, countries like Bangladesh, Ethiopia, Liberia, that it is not only about health solutions whose lives could have been saved if goals Malawi, Nepal, Timor-Leste, and the United and that poverty reduction, better nutrition are met on time. Presently, only two regions Republic of Tanzania have already reduced and education, protection of children, birth in the Asia Pacific are on track to meet their their under-five mortality rates by two-thirds registration, and achieving gender equality 2015 deadline- East Asia and Pacific. or more since 1990. Six of these countries are interrelated important elements that Globally, pneumonia, diarrhea, are low income, proving that low national help children survive and thrive. malaria and newborn conditions like income is not a barrier to making faster gains “Achieving Universal Health Care is prematurity are still the main causes of in child survival. a top priority of the Aquino administration. deaths and kill about 6,000 children younger Many middle-income countries The Department of Health is taking this than five years every day. The poorest children have also made tremendous progress in course to ensure that health services and always fall victim to these easily preventable reducing under-five deaths, and most information reach all mothers and children, and treatable diseases. high-income countries have also seen especially the poorest who need them most,” Even with the advances in battling sharp declines since 1990. This only proves Philippine Health Secretary Enrique Ona said. childhood diseases, pneumonia and diarrhea that rapid decreases even in high-income A Promise Renewed is a call for remain as the leading causes of deaths countries are possible. action anchored on the government’s among under-fives, killing almost 5,000 In the Philippines, there are concrete flagship health campaign for Universal children every day. achievements in terms of reducing under- Health Care with the support of UNICEF, Malaria, on the other hand, five mortality from 59 per 1,000 live births USAID, WHO, and UNFPA. remains a significant cause of child death, in 1990 to 30 in 2012. Despite this decline, The time has come to recommit killing about 1,200 under-fives every day. however, much still needs to be done. The to child survival and renew the promise to The disease is concentrated mostly in Sub- country has to further reduce its maternal give every child the best possible start in Saharan Africa, where 14% of child deaths and infant mortality targets under the MDG. life. Achieving our MDG on time will mean are recorded. For 2015, these two indicators are set at 52 millions of lives saved from preventable Despite declining patterns globally, and 19 per 1,000 live births, respectively. diseases. Let us renew and review our neonatal deaths are growing as a share commitment. of growing under-five deaths amid faster TAKE ACTION, NOW progress in reducing mortality in the post- The need to take drastic action is neonatal period. It is also harsh to note that now if we want to save millions of lives. The most neonatal deaths are preventable. opportunity to end preventable child deaths West and Central Africa requires a has never been greater than it is today. lot of focus and attention for child survival Proven solutions and global and national because it is lagging behind all other efforts have saved the lives of 90 million regions. West and Central Africa is also the children globally in the past 22 years. only regions not to have halved its under- five mortality rates since 1990, and the only

May - June 2014 I HEALTHbeat 9 Child Survival Renewing the Promise for Kalusugan Pangkalahatan Keynote Speech of Secretary Enrique Ona during the Stakeholders' Forum on Enhancing Capacities to Save Mothers and Children

The Department of Health would like to thank our ever-dependable health and development partners for organizing this stakeholders’ forum on enhancing capacities to save mothers and children. I understand that today’s gathering is related to a 2012 international mobilization led by the governments of Ethiopia, India, and the United States together with UNICEF. Back then, there was “A Call to Action” for an ambitious yet achievable goal: to end preventable child deaths.

“Ending preventable child deaths” has been defined to mean :

a. Giving children a healthy start by providing pregnant mothers with quality antenatal care and nutrition during pregnancy; b. Giving newborns a safe delivery, the ability to breathe in the first crucial moments of life, and proper nourishment to avoid stunting; c. Ensuring that newborns are sheltered, breastfed, kept warm and shielded from diseases like HIV; and d. Protecting children from infectious diseases like malaria and pneumonia with vaccines, bednets, and antibiotics.

“A Call to Action” was then followed recently by “A Promise Renewed” or APR, where a broader set of partners in health and development reunited around the same goal of ending preventable child deaths. APR identified five critical areas by which dramatic reductions in preventable child deaths can be achieved through concerted action . Attention was given to the area of geography, which refers to scaling up efforts in priority areas that account for 80 percent of all under-five deaths. Then, stakeholders were urged to look at high-burden populations, in particular to strengthen health systems to increase coverage among underserved populations, including rural and low-income groups. High-impact solutions were also called for in order to better address the five conditions responsible for almost 60 percent of child deaths – pneumonia, diarrhea, malaria, pre-term birth complications, and intrapartum-related complications. Gender equality was cited as a paramount concern, in that investments in education for girls and women were seen as necessary to empower them to make informed decisions that impact their lives. Finally, it was understood that mutual accountability should prevail by building broad-based political support for maternal, newborn and child survival; monitoring progress against a set of common metrics; and encouraging public dialogue on the triumphs and challenges of efforts to accelerate declines in preventable maternal, newborn and child deaths. Here in the Philippines, protecting the lives of both children and their mothers is a mandate enshrined in the 1987 Constitution which is currently in effect. No less than our supreme law or social contract between the government and its people requires that we end preventable child and maternal deaths.

10 HEALTHbeat I May - June 2014 R.A. No. 10354 or the Responsible Parenthood and Reproductive Health Act of 2012 (RPRH Law) is the Philippine government’s latest renewal of its promise to save the lives not only of women in general and mothers in particular, but also of children. The honorable Supreme Court of the Philippines (SC) has already declared the RPRH Law to be “not unconstitutional”, with the exception of a few items. Furthermore, the SC has likewise lifted its Status Quo Ante Order on the RPRH Law, which means that the provisions in the republic act and its implementing rules and regulations not touched by the SC can now be fully implemented. “Reproductive health care” as defined in the RPRH Law allows for the introduction and use of high-impact solutions in maternal, infant, and child health and nutrition. Drugs and devices identified by the UN Commission on Life-Saving Commodities , which include commodities spanning the full continuum of reproductive, maternal, newborn, and child health (RMNCH) care can now be procured by the DOH and distributed directly to all government health facilities, subject to the requirements of the RPRH Law . Midwives and nurses are now allowed to administer lifesaving drugs such as, but not limited to, oxytocin and magnesium sulfate . Mothers will now be able to practice healthy timing and spacing of pregnancy (HTSP), which is an intervention to help women and families delay or space their pregnancies to achieve the healthiest outcomes for women, newborns, infants, and children, within the context of free and informed choice, and taking into account fertility intentions and desired family size. The RPRH Law, through its Declaration of Policy, also prioritizes the provision of services to high-burden populations and vulnerable groups in identified geographical areas, by giving preferential access to those identified through the National Household Targeting System for Poverty Reduction (NHTS-PR) and other government measures of identifying marginalization. Also complementary to the RPRH Law is the Universal Health Care (UHC) or Kalusugan Pangkalahatan (KP) program of the DOH which strengthens both the supply and demand side of health systems where mothers and their children shall have access to quality care. The RPRH Law also promotes gender equality. It establishes “reproductive health rights” to be the “rights of individuals and couples, to decide freely and responsibly whether or not to have children; the number, spacing and timing of their children; to make other decisions concerning reproduction, free of discrimination, coercion and violence; to have the information and means to do so; and to attain the highest standard of sexual health and reproductive health”. The State is also now required to provide age- and development-appropriate reproductive health education to adolescents (including young girls), concerning “values formation; knowledge and skills in self-protection against discrimination; sexual abuse and violence against women and children and other forms of gender based violence and teen pregnancy; physical, social and emotional changes in adolescents; women’s rights and children’s rights; responsible teenage behavior; gender and development; and responsible parenthood”. Finally, the RPRH Law ensures mutual accountability. Broad-based political support and dialogue is ensured by recognition of the active participation of Civil Service Organizations (CSOs) which is comprehensively defined to include not only non-government organizations (NGOs) and people’s organizations (POs), but also faith-based organizations and other citizen’s groups. The CSOs are being invited by government to help plan and monitor programs and projects, engage in policy discussions, and actively participate in collaborative activities. I am quite confident that the portions of the RPRH Law and its implementing rules not found to be unconstitutional by the SC do provide the necessary health policies and directives that will readily synergize with the five critical areas named by the APR effort. Your DOH is now in the process of revising the implementing rules of the RPRH Law to make them consistent with the specific rulings of the SC. We invite all concerned stakeholders present here and with us in spirit and intent to support and join the DOH as it prepares for and proceeds with full-scale implementation of the sustained provisions of the RPRH Law and its implementing rules, if only at least to manifest that yes, we are all renewing our promise to end preventable child and maternal deaths.

May - June 2014 I HEALTHbeat 11 Maternal Health "We Are Not Letting Mothers Die" Bureau of Local Health Systems Development-DOH and Zuellig Family Foundation

In the Philippines, the latest health officers of 263 municipalities out In terms of constructing more maternal mortality ratio (MMR) reported is of the targeted 609 underwent the first facilities, Secretary Ona said that the 211 as of 2011, which is nowhere near the Municipal Leadership and Governance government, through its Health Facility Millennium Development Goal (MDG) target Program (MLGP). Enhancement Program, is not only looking of 52 by 2015. However, the Department of According to Health Secretary to build more facilities but also to make sure Health (DOH) is not about to let the country Enrique T. Ona, the program has so far “these are functioning, complete with health miss the target even if it is just a year away. resulted in having mayors who now realize human resource and services, and accredited “We are not letting mothers die” is that they must not only acknowledge by Philhealth”. And once these are in place, the battle cry of the DOH when it intensified existing health problems but must also take mayors must “issue policies and ordinances its campaign to make sure the Philippines the extra step of being part of the solution. that would support the use of these facilities, meets its maternal health target under the Furthermore, in a speech of encourage the poor to avail of the services MDG No. 5. Secretary Ona delivered by DOH Bureau of through incentives and establish a functional The DOH partnered with the Local Health Systems Development Director referral system in their community”. Zuellig Family Foundation (ZFF) in May 2013 Nestor Santiago Jr. during the HLGP Learning For Regional Director Abdullah through a Memorandum of Understanding Forum in Antipolo City on 26-27 March 2014, Dumama of Region XI, the HLGP has been to implement the ZFF’s Health Change Model he emphasized that “despite numerous very helpful because it deepened the which has helped lower maternal deaths in efforts, inequity still exists and access to understanding of local chief executives about areas where ZFF has worked before. In this quality health facilities and services are still local health system and in turn, enabled model, leadership has been shown to be a difficult, especially for the poor and the most them to create municipal health plans. key instrument to improve health outcomes, vulnerable segment of the population, the According to Dr. Dumama, “You will not fail hence, the focus on local chief executives and mothers and children.” when you have plans”. health leaders. At the forum, the DOH Regional With the program, DOH and ZFF The partnership program between Directors presented before Secretary Ona foresee that the Philippines will achieve the DOH and ZFF, called the “Health Leadership their respective region’s MMR and IMR MDG target on maternal health by 2015 with and Governance Program (HLGP),” began in as well as their specific strategies to help the reducing rate of collective MMR and IMR August 2013 and will run until 2015. As of provinces, cities and municipalities reduce of municipalities. last February this year, mayors and municipal their mortality rates and meet the MDGs.

12 HEALTHbeat I May - June 2014 Health Information DOH FILES NOW OUT The Department of Health (DOH) adds another publication to its roster of public information materials designed to make the public aware of its programs and efforts to promote health and prevent diseases. Named DOH Files, the eight-page, full-color publication focuses on priority and current DOH programs, issues and concerns to be published monthly. With 10,000 copies per issue, its contents will also be carried by a popular health/medical newsletter or magazine with 30,000 circulation. The main recipients through mail of DOH Files are local health officials, local government executives, legislators and other health partners.

The DOH FIles' second issue.

May - June 2014 I HEALTHbeat 13 Hospital Health Introducing the Hospital Accreditation Committee by Roxanne Austine R. Estrella, RN and Harold James E. Doroteo, RN DOH Health Policy Interns/Research Fellows

Pursuant to the strategic thrust Canada International, and the National accreditation fees that would cover all the costs of “Improved access to quality hospitals Accrediting Body for Hospitals from India. of accreditation, the DOH or PhilHealth would and health care facilities,” of the Kalusugan have to support it with a grant or subsidy. Pangkalahatan (KP) or Universal Health History of HAC However, because of its non-governmental Care, the Department of Health established The vision of a national accrediting or private nature, there were legal barriers to the Hospital Accreditation Commission body started when Dr. Enrique T. Ona, then giving governmental funds to PCAHO. (HAC) to serve as the national accrediting newly appointed Secretary of Health, had The establishment of an independent body for hospitals in the Philippines under discussions with the President of PCAHO, key body called Hospital Accreditation Commission Administrative Order 2013 – 0002 dated Department of Health (DOH) and PhilHealth (HAC) was then recommended. The HAC will January 18, 2013. officials on how the quality of hospital be composed of governmental agencies and services could be improved. professional health associations involved in Accreditation of Hospitals in the Philippines He pointed out that there were the operation and management of hospitals. For almost four (4) decades, the several national and international accrediting The primary task of the HAC is to Philippine Medicare Commission and its bodies for hospitals in the country thereby survey the hospitals’ capabilities, policies and successor, the Philippine Health Insurance creating a confusing situation. He wanted to procedures to determine compliance with Corporation (PhilHealth) accredit health establish a single national accrediting body the Enhanced Benchbook Standards recently institutional care providers in the country to for government and private hospitals in the revised by PhilHealth. assure the provision of quality health services country which is separate from the DOH and HAC was accorded recognition as a by both government and private hospitals. PhilHealth. Third (3rd) Party accrediting body pursuant The hospital’s capabilities, processes, A Special Committee, headed by to PhilHealth Board Resolution No. 786, s and outcomes are assessed against a set of then Undersecretary of Health Alexander 2005 and Section 32 of the Implementing criteria called the Benchbook Standards. Padilla was created in July 2010, to study the Rules and Regulations of Rep Act 7875 as Hospitals that are accredited are eligible for designation of a national accreditation body amended by Republic Act 10606. Under reimbursement of hospital expenses and from among existing government agencies the Third (3rd) Party Policy, the results of professional fees. or health professional organizations. the survey by HAC will fulfill one of the There are other hospital On September 10, 2010, the Special requirements for Accreditation as “Advanced accreditation schemes in the Philippines Committee recommended that PCAHO be Participation” by PhilHealth, which will be such as Accreditation for Residency Training designated as the national accrediting body rolled out in January next year. Programs by the medical specialty societies, for hospitals in the Philippines using the for reimbursement of expenses by the PhilHealth Benchbook Standards. These The Role and Organizational Structure of HAC Employment Compensation Commission, for recommendations were endorsed by a Spearheaded by Undersecretary medical tourism by the Philippine Council Consultation Meeting of stakeholders held Teodoro J. Herbosa, HAC aims to improve for Accreditation of Health Organizations on June 11, 2011. the quality of health care services of both (PCAHO), and for quality by the Joint Since PCAHO as the national government and private hospitals in the Commission International, the Accreditation accrediting body would not be able to charge Philippines.

14 HEALTHbeat I May - June 2014 HAC intends to ensure that the equipment and infrastructure projects acquired Dr. Leizel Lagrada, PhilHealth Vice through the Health Facility Enhancement Program (HFEP), the new staffing pattern and the President/OIC of Quality Assurance Group, program of Human Resource Development, and others are properly utilized to support the explained the policies and procedures provision of quality hospital care. of Accreditation by PhilHealth. Dr. Jose It is projected that there will be a significant increase in the income of hospitals, Acuin, PhilHealth Consultant, presented the especially government, from PhilHealth due to subsidy of membership premiums of the lowest enhanced PhilHealth Benchbook Standards 40% of the population by national and local governments. This will improve the capabilities of and the Scoring and Rating System. the hospitals to provide quality health care. On the second day, Mr. Manuel Tan The commission is composed of government agencies and health professional (guest facilitator) orchestrated a workshop organizations that are considered major stakeholders in the accreditation of hospitals. on Strategic Planning where participants Regular and alternate members are nominated by the DOH, PhilHealth, PCAHO, Philippine identified critical issues and were divided Hospital Association (PHA), Philippine Medical Association (PMA), Philippine College of into groups for further discussions. Hospital Administrators (PCHA), Private Hospital Association of the Philippines, Inc. (PHAPI), Undersecretary Herbosa led the drafting of and Philippine Nurses Association (PNA). an Action Plan for 2014.

HOSPITAL ACCREDITATION COMMISION (HAC) MEMBERS Future Steps DEPARTMENT OF HEALTH (DOH) Regular Member: Usec. Teodoro Herbosa (Chairperson) HAC sent two members to Alternate Member: Asec. Gerardo Bayugo participate in a Training of Trainers on PHILIPPINE HEALTH INSURANCE CORPORATION (PHIC) Regular Member: Dr. Francisco Soria Survey for Enhanced Benchbook Standards Alternate Member: Dr. Leizel Lagrada conducted by PhilHealth Consultant Dr. PHILIPPINE COUNCIL ON ACCREDITATION OF HEALTHCARE ORGANIZATIONS (PCAHO) Acuin. Regular Member: Dr. Tomas P. Maramba (Vice-Chairperson) HAC will conduct Training of Alternate Member: Dr. Ricardo Costes Surveyors in the last week of June 2014. The PHILIPPINE HOSPITAL ASSOCIATION (PHA) trainees will be from those who attended Regular Member: Dr. Bu Castro (Secretary) the Orientation on Quality in Health and Alternate Member: Dr. Ruben Flores Accreditation nominated by the member PHILIPPINE MEDICAL ASSOCIATION (PMA) organizations. In the second half of 2014, Regular Member: Dr. Aileen Riego-Javier Alternate Member: Dr. Hermogenes Jarin HAC will accept applications for survey and conduct survey of hospitals. utilizing the PHILIPPINE COLLEGE OF HOSPITAL ADMINISTRATORS (PCHA) Regular Member: Dr. Ricardo F. Adriano, Jr. Enhanced Benchbook Standards. Those who Alternate Member: Dr. Jessie H. Contreras pass the survey will be eligible for Advanced PRIVATE HOSPITAL ASSOCIATION OF THE PHILIPPINES, INC. (PHAPI) Participation in PhilHealth Accreditation in Regular Member: Dr. Rustico Jimenez (Treasurer) January 2015. Alternate Member: Dr. Irineo Bernardo III To promote the role of HAC as the PHILIPPINE NURSES ASSOCIATION (PNA) national accrediting body for hospitals, a Regular Member: Ms. Mabel San Juan Alternate Member: Mr. Edward B. Malzan year-round advocacy campaign is currently being rolled out to various hospitals, Orientation and Strategic Planning Workshop institutions and professional organizations On December 5 – 6, 2013, HAC conducted a two-day orientation and strategic affected by accreditation of hospitals. The planning attended by selected representatives from the HAC member organizations. Commission is planning for the induction of On the first day, there was orientation on the concepts and principles of quality in its members by the Secretary of Health and health services presented by Dr. Marilyn Yap, Chair of the Committee on Standards of PCAHO. its official launch in June 2014. This was followed by the presentation of the concepts and process of accreditation by Dr. Tomas P. Maramba, HAC Vice-Chairperson.

May - June 2014 I HEALTHbeat 15 Motorist Health DOH: ZERO TOLERANCE for DRUNK and/or DRUGGED DRIVING

Don’t drink and/or use drugs and total reported crash related injury cases. or homicide, the penalty of three (3) months drive. Driving under the influence of imprisonment, and a fine ranging from Health Secretary Enrique Ona today alcohol (DUIA) refers to the act of operating Php20,000 up to Php80,000 will be imposed; urged drivers and motorists of both public a motor vehicle while the driver’s Blood if the violation resulted in physical injuries, and private vehicles to refrain from driving Alcohol Concentration (BAC) has reached the penalty provided in Article 263 or Article while under the influence of alcohol, and/or intoxication levels set by the DOH as 249 of the Revised Penal Code, whichever is dangerous drugs and similar substances. determined by alcohol breath analyzers. higher, and a fine ranging from Php 100,000 This is in line with the Implementing BAC refers to the measure of the amount of to Php 200,000; and if the violation resulted Rules and Regulations (IRR) of Republic Act alcohol in a person’s blood. in homicide, the penalty provided in Article No. 10586, otherwise known as the “Anti- Thus, drivers of trucks, buses, 249 of the Revised Penal Code and a fine Drunk and Drugged Driving Act of 2013.” motorcycles, and other public utility vehicles ranging from Php 300,000- Php 500,000. This Act penalizes any person caught driving who are found with more than 0.0% of BAC The non-professional driver’s under the influence of alcohol, dangerous will be penalized for DUIA. On the other hand, license of a person found to have violated drugs and similar substances. drivers of private motor vehicles weighing the law will be confiscated and suspended “With the new IRR, the Department 4500 kg below who are found with 0.05% or for a period of 12 months for the first of Health (DOH) sets the parameters on more BAC or level of intoxication will also be conviction and permanent revocation for testing drunk and drugged drivers using penalized. Examples of these private motor the second conviction. On the other hand, alcohol breath analyzers (ABAs) and drug vehicles are sedans, SUVs, AUVs, pick-ups, the professional driver’s license will be testing kits,” said Ona, adding that these and vans. confiscated and permanently revoked for the means of testing should comply with the For those suspected to be driving first conviction. The permanent revocation of standards prescribed by the agency and used under the influence of dangerous drugs a driver’s license will disqualify the person only by deputized law enforcement officers and other similar substances (DUID), the from being granted any kind of driver’s nationwide, he added. driver will be subjected to a drug recognition license in the future. Based on the latest DOH Online protocol, then screening test and a The IRR is jointly prescribed by National Electronic Injury Surveillance confirmatory test. the DOH, Department of Transportation System (ONEISS), a total of 3,557 transport “This is another effort from the and Communications (DOTC), Department / vehicular crash-related injury cases were Department to contribute to the decrease in of Interior and Local Government-National reported from October-December of 2013, the number of motor accidents and injuries; Police Commission (NAPOLCOM) to carry out with the National Capital Region registering among other efforts such as the enactment the provisions and implementations of this the highest reported cases at 19.9% or 708 of Republic Act 8750 in 1999 requiring Act. It took effect last June 1. cases. the mandatory use of seat belts among “The overall goal here is to reduce Topping the list of the reported risk motorists, as well as the improvement of accidents and injuries in the country, and factors for transport/vehicular crash related capacity of our health facilities to respond to the DOH is continuously working with our injury cases was alcohol/liquor at 8.7% or such cases,” Ona further explained. partners to promote injury prevention, road 309 cases; while motorcycle was the most A driver found to have been DUIA/ safety and for other health care services,” Ona common mode of transport of those who were DUID will be penalized as follows: if the concluded. (Media Relations Unit - DOH) injured, accounting for 57.6% or 2,049 cases of violation did not result in physical injuries

16 HEALTHbeat I May - June 2014 Motorist Health DISSECTING THE ANTI-DRUNK AND DRUGGED DRIVING ACT OF 2013 by Dr. Clarito U. Cairo, Jr., DPSVI, DPCOM Program Manager, Violence & Injury Prevention Program Disease Prevention & Control Bureau - DOH

Road crashes have become rampant DUIA or DUID Probable causes include traffic in this age of urbanization, motorization, and offenses like lane straddling, making sudden mobility although many cases have been Driving under the influence of stops, over-speeding, swerving, or weaving. under reported. As a matter of fact, they are alcohol (DUIA) refers to the act of operating a In the course of apprehension for another consistent as the leading cause of mortality motor vehicle while the driver’s blood alcohol traffic offense, the evident smell of alcohol in the country among the different causes concentration (BAC) level has, after being in a driver’s breath, generally slurred speech of injuries (including mauling/assault, falls, subjected to an alcohol breath analyzer in response to questioning, bloodshot or and drowning) based on partial reports from (ABA) test, reached the level of intoxication. reddish eyes, flushed face, poor coordination, the Department of Health’s Online National A driver of a private motor vehicle with a difficulty in understanding and responding Electronic Injury Surveillance System gross vehicle weight not exceeding 4500 intelligently to questions will also be (ONEISS) for the period of 2010-2013. The kg (for example: sedans, SUVs, AUVs, pick- considered as probable causes. intake of alcoholic beverages has been ups, vans), a BAC of 0.05% or higher will be The LEO will then direct the tagged as the leading risk factor associated considered DUIA. apprehended driver to step out of his vehicle with road traffic injuries. On the other hand, drivers of and will inform him of his assessment and In May 2013, Republic Act 10586 trucks, buses, motorcycles, and public utility will proceed to perform all of the following “An Act Penalizing Persons Driving under the vehicles who have a BAC of more than 0.0% field sobriety tests (FSTs): Influence of Alcohol, Dangerous Drugs, and will be considered DUIA. Similar Substances, and for Other Purposes”, Driving under the influence of 1.) The Eye Test (horizontal gaze nystagmus) otherwise known as the Anti-Drunk and dangerous drugs and other similar substances refers to horizontal or lateral jerking of the Drugged Driving Act of 2013, was signed (DUID) refers to the act of operating a motor driver’s eyes as he / she gazes sideways into law. The Department of Transportation vehicle while the driver, after being subjected following a moving object such as a pen or and Communications (DOTC), Department of to a confirmatory test is found to be positive the tip of a penlight held by the LEO from a Health (DOH) and Department of the Interior for use of any dangerous drug. Only ABAs distance of about one foot (1 ft) away from and Local Government (DILG) through the and drug testing kits that comply with the the face of the driver; National Police Commission (NAPOLCOM) standards prescribed by the DOH shall be were tasked to prescribe jointly the used by deputized law enforcement officers Implementing Rules and Regulations (IRR) (LEOs) nationwide. of Republic Act 10586. Although the said IRR The LEO will flag down the motor was already signed by the heads of the three vehicle only after establishing the probable departments last April 2014, it took effect cause that the driver is under the influence starting June this year. of alcohol, dangerous drugs and/or other similar substances.

May - June 2014 I HEALTHbeat 17 2.) The Walk-and-Turn requires the driver only. If a driver has passed the FSTs and / or The biggest challenge now is on to walk heel-to-toe along a straight line for ABA test, he will no longer be subjected to the enforcement by the Land Transportation nine (9) steps, turn at the end and return to drug screening test. Office, Philippine National Police, the point of origin without any difficulty; and Metropolitan Manila Development Authority PENALTIES and local government units (LGUs) which A driver found to be DUIA/DUID will be could spell the difference between success penalized as follows: and failure of its implementation as well as between safety and fatality among the 1.) If the violation did not result in physical motorists / vulnerable road users. injuries or homicide, the penalty of three (3) Road safety is such a big months imprisonment and a fine ranging responsibility of every road user. RA 10586 from PhP20,000 up to Php80,000 will be will definitelyboostawareness on personal imposed; responsibility and discipline towards attaining road safety. 3.) The One-Leg Stand requires the driver 2.) If the violation resulted in physical to stand on either right or left leg with both injuries, the penalty provided in Article 263 arms on the side. The driver is instructed to or Article 249 of the Revised Penal Code, keep the foot raised about six (6) inches off whichever is higher, and a fine ranging from the ground for thirty (30) seconds. PhP100,000 to PhP200,000; and

3.) If the violation resulted in homicide, the penalty provided in Article 249 of the Revised Penal Code and a fine ranging from PhP300,000- PhP500,000.

The non-professional driver’s license of a person found to have violated the law will be confiscated and suspended for a If the driver passes all of the three period of 12 months for the first conviction FSTs, the driver shall be apprehended for and permanent revocation for the second the other traffic offense only. If the driver conviction. fails any of the FSTs, the LEO will proceed to On the other hand, the professional determine the driver’s BAC level through the driver’s license will be confiscated and use of the ABA on site. permanently revoked for the first conviction. A driver of a motor vehicle who The permanent revocation of a driver’s license refuses to undergo the mandatory testing as will disqualify the person from being granted required will be penalized by the confiscation any kind of driver’s license in the future. and automatic revocation of his / her driver’s license. CHALLENGE A driver who, after ABA testing, Indeed, the intention of RA 10586 registers a BAC higher than the prescribed is to prevent drivers who are under the limit shall be put under arrest and the influence of alcohol and/or dangerous drugs motor vehicle impounded. In case of a BAC to roam the streets thereby minimizing, if within the allowed limit, the driver will be not eliminating, road crashes. apprehended for the other traffic offense

18 HEALTHbeat I May - June 2014 Infection Control MERS-CoV on the Loose? by Elizabeth G. Mascareñas, RN. MPH HEALTHbeat Staff

While the Christian world was question that remains about this virus is the The DOH also received a report that five other busy preparing for the Holy Week, the route by which humans are infected, and the Filipino workers in Al Ain City in UAE were Philippines was shocked with the news of a way in which they are exposed. quarantined after routine contact tracing. MERS-CoV case entering the country. Most patients who tested positive The DOH, through its National for MERS-CoV had neither a human source Epidemiology Center (NEC), reported that What is MERS-CoV? of infection nor direct exposure to animals, the husband of one of the quarantined OFWs According to the US Centers for Disease including camels. It is still unclear whether in Al Ain had visited his wife and returned to Prevention and Control (CDC), the Middle East camels, even if infected with MERS-CoV, play the Philippines last April 6. The husband was Respiratory Syndrome (MERS) coronavirus (CoV) a role in transmission to humans. Further quarantined at home and did not show any is a strain of coronavirus that causes MERS, a genetic sequencing and epidemiologic data signs or symptoms of the disease. respiratory illness. MERS-CoV is a beta coronavirus are needed to understand the role, if any, of Because of this, the DOH advised that that was first reported in 2012 in Saudi Arabia. camels in the transmission of MERS CoV to any person flying in the country who presents Also called “novel coronavirus,” or “nCoV”, MERS- humans, WHO added. with severe respiratory illness within 14 CoV is different from the other coronaviruses that Unfortunately, there is limited days since the day of arrival and with history have been found in people before. data on its transmission but experts said of travel to the Middle East or any Arabian MERS is a highly fatal respiratory that it could possibly be through direct Peninsula country (includes Jordan, Iraq, illness presenting as an influenza-like illness contact of household members and health Kuwait, Bahrain, Qatar, UAE, Oman, Yemen characterized by fever, cough and often with care providers to confirmed cases. The and Saudi Arabia) should be tested for MERS- diarrhea. In August 29, 2013, a forty-one year- diagnosis is made through Polymerase Chain CoV. These cases are reported to the NEC and old Filipina nurse died of severe MERSCOV Reaction using nose and throat swab and the the Research Institute for Tropical Medicine infection in an undisclosed hospital facility treatment remains supportive and based on (RITM) for confirmation of the diagnosis in Riyadh, Kingdom of Saudi Arabia. Her the patient’s clinical condition. However, despite these events, no embalmed body was repatriated and brought Meanwhile, last April 11 this year, travel restrictions to and from any Arabian home in a hermetically-sealed coffin for final the United Arab Emirates (UAE) Ministry of Peninsula country were imposed. Filipino interment in November of the same year Interior reported the death of an Overseas travelers to the Arabian Peninsula were advised without the need for special precautions. Filipino Worker allegedly due to MERS-CoV. to avoid contact with persons with influenza-like The World Health Organization While the WHO Country Office in illness and observe frequent hand washing. They (WHO) said that on November 11, 2013, the Manila has yet to confirm this case, Ms. Grace have to submit themselves to any government Ministry of Health of Saudi Arabia announced Relucio- Princesa, the Philippine Ambassador hospital if they become ill within 14 days from that MERS-CoV had been detected in a camel to the UAE received confirmation from arrival and should not visit crowded places until linked to a human case in their country. This National Health Authorities in UAE of the symptoms disappear. Hospitals were instructed to finding is consistent with previously published second Filipino to die of MERS-Cov. report to DOH any patient who maybe suspected reports of MERS-CoV reactive antibodies Immediately, the Department to have MERS-CoV infection. in camels. However, this finding does not of Health (DOH) through its Bureau of Meanwhile, President Benigno necessarily implicate camels directly in the Quarantine (BOQ) was alerted just in case the Aquino designated Dr. Lyndon L. Lee Suy as chain of transmission to humans. The critical remains are brought back to the Philippines. the DOH Spokesperson to head and mobilize

May - June 2014 I HEALTHbeat 19 the Inter-agency Task Force on MERS-CoV contact with him for the duration of the General principles in contact tracing for to create awareness among our people on flight. They were all at risk of infection. MERS-CoV: MERS-CoV and to prevent the spread of this In order to validate the result, RITM 1. Contact tracing and monitoring is communicable disease. again submitted the index passenger to a second considered only for the initial cases test and the result was negative. The patient was found at the start of the outbreak. Etihad Airlines flight EY 0424: The Carrier eventually cleared of MERSCoV infection. Given the epidemiologic characteristics As there are tens of thousands of As a health precaution, the DOH of coronaviruses, i.e., these viruses overseas Filipino workers (OFWs) entering approved the issuance of a Bureau of are contagious even before the onset and exiting from the Arabian Peninsula, Quarantine alert bulletin to those travelling of illness and have potential for it was crucial for the DOH to be vigilant to from the Arabian Peninsula and through our asymptomatic cases to shed virus, such prevent the MERS-CoV from entering and international airports so that those who may tracking will not be an effective way spreading in the country. be affected by the MERS-CoV will be given to control the outbreak once sustained However, on April 15, 2014, Etihad prompt assistance. The topic MERSCoV is now community transmission in a particular Airlines flight EY 0424 brought to Manila a 45 included in the Pre-Departure Orientation area is established. year-old Filipino male nurse together with Seminar (PDOS) of our OFWs. 2. The goal of timely case and contact 413 other passengers. DOH also established 24-hour identification is to limit the spread of The said male nurse (who was hotlines that may be called by the citizens MERS-CoV to limit the impact of the positive for the MERSCoV as tested by an and foreign nationals residing in the disease on the health care system. UAE medical facility and, therefore, was Philippines who may need assistance with 3. Contact tracing focuses on the subset of considered as the country’s index passenger), regards to MERS-CoV. the population most likely to be at risk of was previously exposed to the Filipino The following numbers are the DOH infections and in the network of transmission paramedic who died of MERS-CoV last April hotlines for MERS-CoV: 711-1001; 711-1002; 0922- routes. However, contact tracing interviews 11, 2014. The index passenger, who has 884-1564; 0920-949-8419; 0915-772-5621. should always be voluntary. been confirmed as the first reported case in 4. The public health benefits derived from the country, had undergone test in UAE but Contact Tracing contact tracing largely depends on the was able to go home without waiting for the Because of the entry of the index organizational capacity to ensure quality result of the examination. passenger to our country, the DOH initially in the conduct of contact tracing. When Fortunately, the DOH was able conducted contact tracing of the 12 passengers staff or logics resources are limited, to track the index passenger while he seated near the index passenger. However, contact tracing becomes ineffective. was on his way home to his province and to ensure that MERS-CoV will have no chance 5. It is important to determine the extent of requested his relatives and well-wishers to of penetrating the country, President Aquino contact tracing to be implemented. When it subject themselves to testing and medical ordered the Task Force to track and test all the is clear that the disease can be passed onto observation at a DOH regional hospital. 414 passengers of Etihad Airlines flight EY 0424. others at a rate faster than that of finding Since ten (10) days had elapsed According to the DOH interim the contacts, it is time to stop the contact from the reported testing date in UAE, the guidelines number 2 of the enhanced tracing and move on to the community – Task Force decided to perform another test surveillance of MERS-CoV on contact tracing, based containment measures. on the index passenger on 16 April at the contact tracing is the identification and The government spent at least RITM who tested negative. diagnosis of a person who may have come P2.07 million in its efforts to track, test and Lee Suy explained that at the time into contact with an infected person. monitor all 414 passengers of Etihad Airlines he was traveling from Abu Dhabi to Manila Contact tracing plays an important flight EY 0424. Dr. Lyndon Lee Suy said the last Tuesday, 15 April --- a seven-hour flight role in containing outbreaks of infectious photo chromatography reaction test, which --- he was still deemed a positive carrier diseases. The main purpose of contact tracing requires a nose and throat swab from the of the MERS-CoV, and that all of his fellow is: to confirm diagnosis; determine the extent tested person, costs P5,000 for each test. passengers were exposed to him, including of secondary transmission; identify appropriate “Consider the economic cost of parents any number that may have been in close control measures for the specific disease. unable to report for work and losing income, or

20 HEALTHbeat I May - June 2014 children missing school. A widespread MERS- Lee Suy emphasized that the threat immunity ----- they are all at high risk of CoV infection will pose a graver, bigger problem of MERS-CoV does not end with the testing of contracting MERSCoV,” Health Secretary for the Philippines,” said Lee Suy. the Etihad passengers, adding that “we have to Enrique Ona declared. “The Philippines has implemented the be more vigilant and ready for any other threat These high-risk groups are advised to ‘no regrets policy’ in dealing with the MERS-CoV. that may endanger the Filipino’s health.” delay their trips to the Arabian Peninsula, where The Task Force is aggressively tracking down the “What we are doing with the Etihad according to the World Health Organization remaining passengers. No country can question Airlines flight EY 0424 passengers now, we (WHO), “699 laboratory-confirmed cases of how the Philippines is responding presently to have done in the past. Let me make this clear. human infection with MERS-CoV have been the MERS-CoV threat,” Lee Suy added. We have this active surveillance since August reported, including at least 209 deaths.” Meanwhile, President Aquino 2012. We are not just focusing on Flight 424. Overall, 63.5% of cases are male and directed all government agencies concerned to We are also looking at other flights. The the ages ranged from 9 months to 94 years old. sit down together and craft a "more concrete, surveillance is ongoing,” Lee Suy said. According to WHO, the affected more detailed, and more comprehensive As of May 7, only nine of the 414 countries in the Arabian Peninsula include response to emerging infectious diseases." passengers have not yet been contacted or Iran, Jordan, Kuwait, Lebanon, Oman, Qatar, tracked down by the Task Force. Three hundred Saudi Arabia (KSA), United Arab Emirates The following are the partner government ninety-six (396) passengers have already been (UAE) and Yemen. agencies in combating MERS-CoV: tested and all tests yielded negative results. Muslim pilgrims gather in Mecca to • the Department of Labor and Meanwhile, a benefit package (such perform rituals based on those conducted by Employment, POEA and OWWA; as cost of laboratory tests) for Philippine Health the Prophet Muhammad during his last visit • the Department of Foreign Affairs, Insurance Corporation (PhilHealth) members to the city. Performing these rituals, known and its foreign posts, especially the who may be suspected or infected with MERS- as the Hajj, is the fifth pillar of Islam and the Philippine embassy in the UAE; CoV will be shouldered by the PhilHealth. most significant manifestation of Islamic • the Department of Justice and the The DOH assured the public, especially faith and unity. Undertaking the Hajj at least Bureau of Immigration; the OFWs based in the Arabian Peninsula and once in his lifetime is a duty for Muslims who • the Department of the Interior and their families and communities, that government are physically and financially able to make Local Government and the Philippine will exert maximum efforts to keep them the journey to Mecca. National Police (PNP); informed and aware of all vital developments. Hajj is expected to fall between • the Department of National Defense, The DOH also extends full assistance through the October 2-7, 2014. Office of Civil Defense and the National various regional and district hospitals, regional Umrah is also known as the "lesser Disaster Risk Reduction Management offices, the Bureau of Quarantine and attached pilgrimage," in comparison to the annual Hajj Council; agencies such as PhilHealth. pilgrimage of Islam. It is a visit one makes to the • the Department of Transportation & As of May 8, 2014, or twenty-three Grand Mosque in Makkah, Saudi Arabia, outside Communications and attached agencies; days after the entry of the index passenger, of the designated Hajj pilgrimage dates. The word • the Presidential Communications the country remains MERS-CoV free. "umrah" means to visit an important place. Operations Office, and its attached In another development, the DOH The exact dates of Islamic holidays agencies --- People’s Television, Radyo recently advised Filipinos who intend to cannot be determined in advance, due to the ng Bayan, Philippine Information Agency perform the Hajj or Umrah pilgrimages in nature of the Islamic lunar calendar. Estimates and Philippine News Agency; and the Arabian Peninsula this year to postpone are based on expected visibility of the hilal • the Presidential Management Service or delay their trips or risk getting infected (waxing crescent moon following a new "The DOH has a plan on dealing with the Middle East Respiratory Syndrome moon) and may vary according to location. with emerging diseases, but it is only a health Coronavirus or MERSCoV. “Filipino pilgrims to Mecca are plan. The President wants to see a bigger, “Persons who are 60 years old and advised to consult a doctor before travelling wider plan involving more agencies. He above, pregnant women, children below to review the risk and assess whether making wants it to be a multi-agency initiative. The five years old, those who have diabetes, the pilgrimage is advisable,” the health chief DOH cannot do it alone," Lee Suy explained. kidney disease, chronic lung disease, weak concluded.

May - June 2014 I HEALTHbeat 21 Muslim Health MERS-CoV From a Muslim Perspective by TATO M. USMAN, MD, MPAIM Department of Health - Autonomous Region in Muslim Mindanao

What is MERS-CoV? person does not show any sign and symptom routinely available and done in countries not of MERS-CoV, that person is said to be free of afflicted with the said virus. The Middle East Respiratory MERS-CoV. Similarly, if the suspected person Syndrome Corona Virus (MERS-CoV) was first is a carrier of MERS-CoV but does not show What is the treatment for MERS-CoV? reported in Saudi Arabia in 2012. Thereafter, the said signs and symptoms of the disease, MERS-CoV cases were reported in other Arab then that person is said to be non-infective or As of now, there is no anti-viral countries like Jordan, Kuwait, Oman, Qatar, asymptomatic. therapy recommended for illnesses caused United Arab Emirates and even in non- by MERS-CoV except palliative or supportive Arabian peninsula countries such as France, What if somebody traveled recently medical care. Meaning, the patients are Italy, etc. to countries with reported MERS-CoV treated symptomatically without addressing In 21 April 2014, the Ministry cases? the viral cause. In fact, there is no available of Health of the United Arab Emirates vaccine yet against MERS-CoV. (UAE) reported an additional 9 laboratory- If someone has a recent travel to confirmed cases of MERS-CoV. countries with reported MERS-CoV cases, he What are the Islamic insights As of 24 April 2014, WHO (World or she should consult a healthcare provider on MERS-CoV? Health Organization) has recorded a total of for medical advice. If he or she has already 250 laboratory-confirmed cases, including developed fever and symptoms of lower In the Noble Qur’an: “Oh you who 93 deaths. respiratory illness such as cough or shortness believe! Obey Allah and Obey Messenger, of breath within 14 days after travelling and those of you who are in authority” (An- How does one get infected from countries in the Arabian Peninsula Nisa: 59). It is clearly stated in this verse the with MERS-CoV? or neighboring countries with MERS-CoV hierarchy of orders to obey. If you happened cases, he or she should consult a healthcare to be one of the suspected carrier of MERS- MERS-CoV has been shown to provider in the area for health evaluation and CoV, then you are obliged to obey health spread from one infected person to another advice. authorities in their efforts to stop MERS- susceptible through close contact. This means CoV. It is contrary to play hide and seek with that during the infective stage, patients What are the tests for MERS-CoV? health authorities, but rather, one has to usually experience severe acute respiratory cooperate with the health authorities and its illness with symptoms of fever, cough, and The polymerase chain reaction other subsidiaries in fighting against MERS- shortness of breath. Its average incubation (PCR) lab test and viral isolation of virus in CoV. period (from exposure to the appearance of the laboratory through a mouth swab can be Moreover, Allah Almighty says in signs and symptoms of disease) is 3-14 days. used to screen or confirm people suspected the Noble Qur’an, “And do not be cast into After the 14 days incubation period and the with MERS-COV; otherwise tests are not ruin by your own hands...” (Al-Baqarah: 195).

22 HEALTHbeat I May - June 2014 Additionally, the Messenger of Allah (PBUH) said: “Do not (impose) harm, nor (inflect) harm”. It can be deduced in the said verse and hadith that one should not let disease harm oneself. For instance, if you are among the passengers of Etihad Airlines that carried a positive MERS-CoV case, then you are obliged to coordinate and cooperate with the health authorities so that an appropriate health care shall be given and further transmission of the disease could be deterred. In Islamic history, Al-Bukhari records the story of `Umar ibn Al-Khattab (may Allah be pleased with him) in this concern (infectious diseases) on the authority of `Abdullah ibn `Abbas who said: `Umar ibn Al-Khattab departed for Sham (the Levant) and when he reached Sargh, a place near Al-Yarmuk, the commander of the (Muslim) army, Abu `Ubaydah ibn Al-Jarrah, and his companions met him and told him that an epidemic of plague had broken out in Sham. `Umar said, "Call for me the early Muhajirun (immigrants to Madinah)." So `Umar called them, consulted them, and informed them that an epidemic of plague had broken out in Sham. Similarly, at that time `Abdur- Rahman ibn `Auf, who had been absent because of some job, came and said (outbreak of plague), “I have some knowledge about this. I have heard Allah's Messenger saying, ‘If you hear about it (an WHO travel notice is Watch (Level 1) will suffice. Likewise, health authorities outbreak of plague) in a land, do not go which advises travelers to countries must be vigilant and do sustained active to it; but if plague breaks out in a country in or near the Arabian Peninsula to surveillance and contact tracing to those where you are staying, do not run away follow standard precautions, such as exposed to MERS-CoV in coordination and from it.’” proper hand washing and avoiding partnership with all stakeholders. Finally, it is not recommended close contact with people who are ill. If however that anyone like Bangsamoro someone has to visit patient or person Allah Almighty knows best. who wanted to travel overseas be suspected with MERS-CoV, the proper postponed or cancelled. As of date, current use of mask and good personal hygiene

May - June 2014 I HEALTHbeat 23 Climate & Health Philippine Health Secretary Addresses the World Health Organization

21 May 2014 - Philippine Health Secretary Dr. Enrique Ona addressed the 67th World Health Assembly at the Palais des Nations in Geneva Switzerland yesterday, 20 May 2014. With climate change and health at the heart of the Assembly’s Debate, Secretary Ona emphasized that “the link between climate and health couldn’t be as relevant, especially to the Philippines, as today.” Secretary Ona shared to the 194 member delegation of international health leaders and policy members the Philippine experience in Typhoon Haiyan – the strongest typhoon to make landfall in recorded history. The typhoon brought widescale destruction which prompted the World Health Organization (WHO) to categorize the needed response a Grade 3, the highest internal emergency category. “There were lessons learned and experiences are carefully studied as the country reviews its existing policies and programs,” the Health Secretary said. His speech drove in the point the important principle of “building back better” in the reconstruction of health structures to make the health system more resilient, more responsive, more adaptable and effective in responding to the effects of climate change as well as mitigating their impact to the public. Climate change has resulted to observable effects to weather and environment that has a direct co-relation to public health. Many prevalent human infections, including malaria, dengue fever, and cholera, are climate sensitive and hence may increase in their incidences should temperatures rise. Philippine Health Secretary Dr. Enrique Ona addresses the World Health Assembly at the The spread of so-called waterborne infections which most Palais des Nation Assembly Hall in Geneva, Switzerland on 20 May 2014. often cause diarrheal illness flourish in the wake of heavy rainfalls due to water contamination. Moreover, many pathogens that cause diarrheal disease reproduce more quickly in warmer conditions. “In this modern age, CLIMATE is recognized as an important determinant for health,” Secretary Ona stressed. In response, the Philippines initiated the development and implementation of the national policy for health action on adaption to climate change, strengthened public health systems including disease surveillance and monitoring, enhanced disaster preparedness and health action in emergencies, and enhanced awareness of the population on climate change. “Health is one of the most visible dimensions of climate change,” according to Secretary Ona. The Health Leader called on the Assembly for a “united front against the health impacts of climate change to achieve universal health care for our people.” In fact, in the Philippines 45 million poor and near poor Filipinos are already covered by the national health insurance. The World Health Assembly is an annual gathering of health ministers, non-governmental organizations (NGOs), health professionals and policy makers to discuss and make decisions on key global health issues. This year, more than 3,000 delegates are attending the Assembly which runs from 19 to 24 May 2014. PRESS RELEASE - Department of Foreign Affairs

24 HEALTHbeat I May - June 2014 Climate & Health The Link Between CLIMATE and HEALTH (Remarks of Health Secretary Enrique T. Ona at the 67th World Health Assembly | May 20, 2014 | Geneva, Switzerland)

The link between climate and health couldn’t be as relevant, especially to the Philippines, as today. Considered one of the most vulnerable countries in the world due to its archipelagic make-up and location, the Philippines experiences an average of 20 typhoons annually, and faces increasing disaster risks with geologic and seismic dangers interacting with meteorological hazards. On the 8th of November 2013, Typhoon Yolanda, or known internationally as Haiyan, a category 5 super typhoon and considered to be the strongest to make landfall in recorded world history, quickly came, and left the Philippines just as quickly, leaving behind unimaginable devastation. About Four (4) million Filipinos or almost a million Filipino families lost their homes, around 6,315 people died and there are still 1,785 people missing. Further, a total of 608 health facilities (42 Hospitals, 105 Rural Health Units and 461 Barangay Health Stations) were damaged. The world watched; the world mobilized and responded; and soon it was just one massive spontaneous action to assist our Government in relief, recovery, and rehabilitation, and in bringing back smiles especially to those who were directly hit. Yolanda or Haiyan, the 24th typhoon that visited the country last year, struck at the time the country was barely up from armed conflict and floods in the South, and a 7.2 magnitude earthquake also in the same region. Haiyan brought together the international community to one massive humanitarian effort to help the Philippines in all stages of responding to the emergency and into the rehabilitation phase. For example, 191 foreign medical teams composed of 3,145 medical staff of doctors, nurses and paramedics arrived immediately few days after the typhoon to assist the Department of Health of the Philippines to respond to the medical needs of our people. I wish to express our sincere thanks, our heartfelt appreciation for the outpouring of support from the international community. To the Director General Dr. Margaret Chan, thank you most sincerely. You mobilized the whole Organization, and through the leadership of Regional Director Dr. Shin Young- Soo, WHO supported us in coordinating health sector response to the emergency. It was so heartwarming, and it meant a lot to see and feel that we were not alone. Thank you. There were lessons learned and experiences are carefully studied as the country reviews its existing policies and programs. Could we have prepared better? Maybe not at that time, but definitely, yes, in the future. As the Government began the difficult road to reconstruction and rebuilding, not only of physical structures but of lives and relationships, the goal of “building back better” becomes the guiding principle for our work. It is good, and it helps to reflect on and understand why such tragic events occur. It brings home the value of preparedness, organized response, concern for each other, the universality of human frailty and the indomitable spirit to rise from whatever adversity and of course, the oft-repeated respect for our environment. In this modern age, CLIMATE is recognized as an important determinant for health. We read about significant increases in deaths as ambient temperature increases; of the relation between the incidence of diarrheal diseases to variations in temperature and precipitation, over space and time; of increases in dengue and dengue hemorrhagic fever as the proportion of the global population exposed to dengue increases. Health hazards have increased due to the insidious effects of increasing temperatures and increased production of certain air pollutants and aero allergens. In the Philippines, for example, a comparison of malaria cases and temperature trends over a 10-year period [1995-2005] showed a significant relationship between increasing prevalence of malaria with increasing temperature. Increases in rainfall, temperature and relative humidity over a 17-year period [1992-2009] also showed increasing trends in cholera cases.

May - June 2014 I HEALTHbeat 25 What then is the link between climate and health? Experts present to us elaborate diagrams and complex figures. But these complex figures only show how health is affected through both direct and indirect exposures in various pathways – through environmental conditions; social and economic conditions or what we consider the upstream determinants of health, and health system conditions. Understanding this helps us to determine what actions the health sector can take as adaptations to climate change and thus appropriately prepare and mitigate the health impacts. In line with this and as a commitment to climate change adaptation, the Department of Health of the Philippines initiated the development and implementation of the national policy for health action on adaptation to climate change, strengthened public health systems including disease surveillance and monitoring, enhanced disaster preparedness and health action in emergencies, and enhanced awareness of the population on climate change. For example, the Philippine Integrated Disease Surveillance and Response was redesigned to incorporate climate change indicators: rainfall, temperature, relative humidity, and solar radiation extremities. The Strategic Plan for Climate Change and Health Adaptation [2014-2016] aims to protect the health of Filipinos by improving the adaptive capacity of the health care delivery system, and prioritizes action on the country’s 20 most vulnerable provinces and 45 million poor and near poor Filipinos that are already covered by our national health insurance. There had been regional agreements and resolutions calling for decisive action to address the health impacts of climate change. But individually, and collegially, more still remain to be done. Clearly, health is one of the most visible “human dimensions” of climate change. The health impacts of climate change are diverse; though some may be uncertain and poorly understood. But these are real, irreversible, potentially very large, and these come on top of many other strains on the health system. However, as what we, as well as many other countries have embarked on, there are multiple opportunities for improving health as we meet the challenges of adaptation and mitigation. The call is for us to do what we should have done yesterday. A united front against the health impacts of climate change is needed to achieve universal health care for our people.

Thank you for your attention.

26 HEALTHbeat I May - June 2014 ASEAN Health PH HOSTS 4th ASEAN DENGUE DAY; CASES LOWER COMPARED TO SAME PERIOD LAST YEAR

Participants of this year's ASEAN Dengue Summit & ASEAN Dengue Day held in Clark Pampanga pose for a souvenir photo. The country takes its turn in the private and non-health public sectors. and the National Capital Region (8.55%). hosting the ASEAN Dengue Day this year in The country’s anti-dengue efforts is Ages of the cases ranged from less than Pampanga, Department of Health (DOH) anchored on the Four o’ Clock Habit, a cleanup 1 month to 96 years old. Majority of the cases Spokesperson Lyndon Lee Suy declared today, activity that starts at 4PM and premised on were male. Most of the cases were from the 5 to adding that the people should continue to be the dengue mosquito’s feeding frenzy hours 14 years age group. There were 99 deaths. vigilant in combating dengue even if there is that start at 4PM. The DOH anti-dengue activities that less reported cases this year. This year’s theme is, “ASEAN Unity contributed to the lowering in the number “The ASEAN Dengue Day is observed and Harmony: Key in The Fight Against of cases include vector control activities, in all ASEAN + 3 member states as part of Dengue.” ASEAN +3 is composed of Brunei such as the promotion of the 4 o’clock the region’s strategy to address this serious Darussalam, Cambodia, Indonesia, Lao habit in communities and following the 4S public health threat,” Lee Suy explained, People’s Democratic Republic, Malaysia, against dengue. The 4S means Search & adding that the ASEAN countries have the Myanmar, Singapore, Thailand, Vietnam, destroy mosquito breeding places, use Self- highest number of dengue infections in Asia- and the Philippines. The +3 is composed of protection measures, Seek early consultation Pacific. The Asia-Pacific region bears 75% of China, Japan, and Korea. for fevers lasting more than 2 days, and Say the current global disease burden. Meanwhile, as of May 31 this year, yes to fogging when there is an impending June 15 was declared ASEAN Dengue a total of 23,867 dengue cases have been outbreak. Additionally, advocacy among Day during the 10th ASEAN Health Ministers’ reported to the DOH’s National Epidemiology stakeholders and interagency collaboration Meeting held in Singapore in July 2010. On Center. This figure is 50.98% lower compared were intensified. this day, member-states hold simultaneous to the same period last year (48,686). “The frequent rains are upon us activities in their countries, all geared towards Most of the cases came from Central and it tells us that we should continue to be raising awareness on dengue and to mobilize Luzon or Region III (10.21%), CaLaBaRZon or vigilant, continue to clean-up at 4 o’clock in resources for the prevention and control of Region IV-A (10.14%), Eastern Visayas or Region the afternoon,” Lee Suy concluded. dengue not only in the health sector but also VIII (9.93%), SoCCSKSarGen or Region XII (9.48%), (Media Relations Unit - DOH)

May - June 2014 I HEALTHbeat 27 Rabies Prevention PHILIPPINES RABIES-FREE by 2020? by Abigail Corpuz-Quetulio HEALTHbeat Staff

A hundred percent fatal but also Dogs were primarily responsible for animal bite victims of potentially rabid preventable. This is rabies. 81.88% of the biting incidents. animals, and Pre-Exposure Prophylaxis (PrEP) to high risk individuals and school Rabies is a zoonosis, a disease The Anti-Rabies Act (RA 9482) children in high incidence areas. that is transmitted from animals to humans The Program also seeks to that is caused by a virus. Human infection In 2007, Republic Act 9482 or the strengthen campaigns for responsible pet usually happens after a transdermal bite or “Anti-Rabies Act of 2007” was signed into law ownership, training of medical doctors and scratch by an infected animal. Every year, which strengthened the efforts of the DOH, nurses on the guidelines on the management around 55,000 people die of rabies, mostly Department of Agriculture (DA), and partner of animal bite victims, and other advocacy in Asia and Africa and dogs are the source of non-government agencies, non-government campaigns such as Rabies Awareness Month the majority of human rabies deaths. (World organizations and private organizations to in March every year and World Rabies Day Health Organization, July 2013) control and eliminate rabies in the country. every September 28. In the Philippines, rabies is Its goal is to eliminate rabies and Moreover, the implementing considered a significant public health declare the Philippines Rabies-Free by year agencies are also mandated to strengthen concern for it is one of the most acutely fatal 2020. promotion of dog vaccination, dog infections and is responsible for the death of The Act is re-defining the mandate population, impounding, field control around 200-250 Filipinos in a year. (National of the National Rabies Prevention and and disposition of unregistered, stray and Rabies Prevention and Control Program Control Program, increasing appropriation unvaccinated dogs. Establishment of a Briefer, May 2014) for rabies prevention and control, and central database system for registered In 2012, there were 231 deaths providing penalties for non-compliance to vaccinated dogs is also needed. due to rabies recorded at the Department of the provisions of the law. The Program should be a multi- Health’s (DOH National Epidemiology Center. Implementing agencies include: agency effort in controlling and eliminating Most human rabies cases were reported in Department of Agriculture (DA), Department Rabies in the country. CALABARZON (38 cases); followed by Central of health (DOH), Department of interior and The amount of Php100M necessary Luzon (26 cases); Ilocos Region (23 cases); Local Government (DILG) and Department to implement the provisions of the Act will be Bicol and SOCCKSARGEN (19 cases).The of Education (DepEd), as well as Local initially charged against the appropriations National Capital Region reported 12 deaths. Government Units (LGUs) with the assistance of the DOH, DA, DILG and DepEd under the In 2013, there were 199 rabies of the Department of environment and General Appropriates Act. For the LGUs, it cases and deaths reported. Most human Natural Resources (DENR), Non-Governmental will be taken from their Internal Revenue rabies cases were reported in CALABARZON Organization (NGOs) and People’s Allotment as well as other local funds. (35 cases), followed by Cagayan Valley Organizations (POs). Thereafter, such sums necessary for its Region (22), Bicol (21), SOCKSARGEN (19), Major strategies to reach its goal continued implementation will be included and Davao (16). The National Capital Region also include the provision of Post-Exposure in the annual General Appropriations Act. reported 9 deaths. Prophylaxis (PEP) to all rabies exposures/

28 HEALTHbeat I May - June 2014 Meanwhile, pet owners who fail The target is to vaccinate at First Aid Advice or refuse to have their dog registered and least 70% of the total dog population. immunized against rabies will be fined for This partnership seeks to fast-track the The DOH advises bite victims to: Php2,000. Likewise, for pet owners who achievement of zero human rabies cases by refuse to have their dog vaccinated will be 2016, a step toward the goal of rabies-free 1. Immediately wash wound/ bite site liable to pay for the vaccination of both the Philippines by 2020. with soap and water for at least 10 dog and the individuals bitten by their dog. Currently, there are 16 islands minutes Pet owners who refuse to have their dog in the country that have been declared 2. Visit any of the government’s 424 put under observation after it has bitten an “rabies-free”. These Islands include: the animal bite treatment centers or any individual will be fined for Php10,000 up to provinces of Siquijor; Batanes, Biliran, health facility for proper management. Php25,000. Guimaras Camiguin and Marinduque, 3. DO NOT: the island of Municipality of Limasawa, a. Depend on tandok, mananambal MOU Signing between DOH and DA Camotes (4 Municipalities), Coron, Culion and other traditional healing and Busuanga of Palawan; Malapascua methods because these remedies In May 2013, the DOH and DA island of Cebu, and Apo and Olympia Island will not prevent rabies. signed a Memorandum of Agreement (MOA) of Negros Oriental. b. Apply garlic and other topical or providing financial assistance to the DA to Both agencies believe that rabies traditional remedies on the bite augment the procurement of anti-rabies can be prevented and that vaccination site/s vaccines amounting to Php 69,545,000.00. coupled with responsible pet ownership can c. Induce bleeding in the wound as With the DA allocated budget of Php40M, indeed help achieve the goal of a rabies-free rabies virus is not found in the the joint rabies program now has Php109.5M Philippines by 2020. blood. fund.

Istatistika

Ano daw ang mas masarap kesa pinaupong manok? 90% of women like men in pink T-Shirt. But ironically, According to 100 women: Pinatayong IBON! 90% of men in pink T-Shirts don't like women.

May - June 2014 I HEALTHbeat 29 Tobacco Control WHO Calls on Governments to Raise Tobacco Taxes

MANILA, 28 May 2014 – On World reducing tobacco use among lower-income with the Ministry of Finance of China and No Tobacco Day (31 May), the World Health groups and in preventing young people from collaborated with researchers in the Central Organization (WHO) in the Western Pacific starting to smoke. University of Finance and Economics and Region urges governments to raise taxes The World Health Report 2010 Johns Hopkins Bloomberg School of Public on tobacco products. Two people die each indicated that a 50% increase in tobacco Health. In consultation with the Research minute from tobacco-related diseases in the excise taxes would generate more than US$ Institute for Fiscal Science of the Ministry Region, which is home to one-third of the 1.4 billion in additional funds in 22 low- of Finance, the team examined available world’s smokers. income countries. In countries such as the evidence on demand for cigarettes for “Increasing the price of tobacco Lao People’s Democratic Republic and Viet the overall population and youth, and the products through taxation is a win-win Nam, the extra revenue can represent 10% impact of taxes on the economy of China situation. It promotes health by discouraging and more of total expenditure on health, using input-output analysis. WHO continues people to take up this deadly habit and providing means to increase government to collaborate with the Ministry of Finance it also increases revenues which can be expenditure and reduce the burden of out- through technical support for analysis of channelled towards initiatives for health of-pocket expenditure. the Chinese tax system, administration and or social welfare,” noted Dr Susan Mercado, WHO is committed to help policy process. Director, Building Healthy Communities and governments design intelligent tobacco Officials from the Ministry of Populations, Western Pacific Region, during tax policies that best satisfy these dual Finance of Viet Nam took part in a tax the opening of a regional workshop on goals of tobacco use reduction and revenue workshop organized by the WHO Regional tobacco taxation and illicit trade organized generation. In the Western Pacific Region, Office for the Western Pacific and received by Southeast Asian Tobacco Control Alliance WHO has worked closely with the ministries technical assistance from WHO on tobacco tax (SEATCA) and hosted by the WHO Regional of finance of Cambodia, China and Viet Nam administration and implementation issues. Office for the Western Pacific in Manila to review existing excise tobacco taxation on Tax administrators prepared a document for last week. “The only ones that lose are the tobacco and explore ways to configure tax the Ministry of Finance specifying areas of tobacco companies,” Dr Mercado added. policy and administration to improve revenue improvement in the current excise system, The WHO Framework Convention collection and reduce tobacco consumption. administration and implementation. on Tobacco Control (WHO FCTC) recommends Cambodian officials from the Pacific island countries have a tax and price policies on tobacco products Ministry of Economy and Finance together Pacific Tobacco Taxation Project to help as a way to reduce consumption. Evidence with WHO and SEATCA assessed the countries increase tobacco taxes through shows that price increases on cigarettes Cambodian tobacco tax system in 2012. workshops, meetings and country-based are highly effective in reducing demand in The collaboration involved evaluating the technical missions. Several countries have countries of all income levels. Higher prices strengths and weaknesses of the current successfully taken measures to increase taxes induce cessation and prevent initiation of tobacco tax system, and subsequently on cigarettes. tobacco use. They also reduce relapse among assessing the impact of a different tax policy those who have quit and reduce consumption proposal designed to improve tax revenue -- In 2013, Cook Islands budget included among continuing users. Research also and public health outcomes for Cambodia. a 33% increase on the import tax for shows that higher taxes are effective in Since 2007, WHO has engaged cigarettes.

30 HEALTHbeat I May - June 2014 -- Fiji successfully increased the excise those deaths are the result of direct tobacco says WHO Regional Director for the Western duty on both cigarettes and alcohol by use while more than 600 000 are the result of Pacific, Dr Shin Young-soo. “Increasing the 10% in 2012. non-smokers being exposed to second-hand retail price of tobacco products through smoke. Approximately one person dies every higher taxes is the single most effective way -- In Papua New Guinea, the 2012 budget six seconds due to tobacco, accounting for to reduce the demand for tobacco.” included a 15% increase in tobacco one in 10 adult deaths. Up to half of current excise tax, and the 2013 budget users will eventually die of a tobacco-related Other recipients from the Western included a further 10% increase. disease. Pacific Region of the World No Tobacco Day Unchecked, tobacco-related deaths Award are the following: -- In Tonga, the 2013 tobacco taxation will increase to more than 8 million annually proposal includes a 15% increase in by 2030. More than 80% of those deaths will -- Professor Teh-wei Hu average price per pack in year one, a be in low- and middle-income countries. (People's Republic of China) 15% increase in year two, and a 13% Moreover, if current trends continue, tobacco increase in year three. may cause 1 billion deaths in this century. -- Dr Wang Longde Every year, Dr Margaret Chan, WHO (People’s Republic of China) In the Philippines, President Director-General, recognizes people and Benigno S. Aquino III, one of the recipients institutions that have made outstanding -- Mr Siosifa Tuitupou Tu’utafaiva, Minister of the World No Tobacco Day Awards 2013, contributions to the advancement of the for Revenue and Customs signed Republic Act 10351 or the Sin Tax Bill policies and measures contained in the (Kingdom of Tonga) into law on 20 December 2012. Incremental WHO FCTC and its guidelines. There are six revenues from the law will be used to fund awardees from each region and globally -- Lord/Mr Tu'i'afitu, Minister of Health health premium subsidy of the poor, fund the there are two recipients of the WHO Director- (Kingdom of Tonga) upgrading and modernization of government General Special Recognition Award. This year, hospitals and facilities, expand public one of these special recognition awards has -- Hon. Tariana Turia, Associate Minister of health programmes, such as immunization been granted to SEATCA. Health (New Zealand) to achieve the Millennium Development “This award recognizes the Goals, hire health workers, and fund health valuable contribution of SEATCA as a regional -- Republic of Palau National Government promotion and implementation research to ally especially in the area of tobacco taxation. (Republic of Palau) support Universal Health Coverage. SEATCA is a key catalyst and leader in tobacco The tobacco epidemic is one of the tax reform in the ASEAN community bringing (World Health Organization – Western Pacific biggest public health threats, killing nearly 6 together various stakeholders and working Region ) million people a year. More than 5 million of closely with ministries of health and finance”

May - June 2014 I HEALTHbeat 31 Tobacco Control Sin Tax Law Effective In Reducing Smoking Prevalence Among Youth and Poor 30 May 2014, Manila – In celebration of the prevalence among those belonging to the making it more affordable than buying per World No Tobacco Day with the theme “Raise 18 to 24 year-old age group as also reduced pack. According to the survey, median price Taxes on Tobacco,” the Department of Health, from 35% in December 2012 to 18% in March of cigarette per stick in the country is at Php together with the Department of Finance, 2014. 3.00 in spite of the price increase. Bureau of Internal Revenue, World Health DOH Secretary Enrique Ona said, DOH Secretary Ona added, “The Organization, and World Bank, presented “Although we’ve been only a year in the implementation of the Sin Tax law is in its results of a national survey showing the implementation of the Sin Tax law, we are initial stage and we are very hopeful that effectiveness of the Sin Tax law in reducing glad to already see a decrease in smoking it will reach its goal of reducing overall smoking prevalence among the youth and prevalence among the youth and the poor, smoking prevalence in the country as the poor. the main groups we aimed to protect tobacco taxes continuously increase each The national survey, conducted by through the law. Reducing overall prevalence year. As of now, the Sin Tax law is already the Social Weather Stations, Inc. (SWS) in of smoking in the country however, will take providing health benefits to Filipinos March 2014, aimed to assess the effects of some time.” by contributing additional funds for the RA 10351, otherwise known as the Sin Tax Survey results showed that there implementation of DOH’s Kalusugan law, a year after its implementation. The is a reduction of smoking prevalence Pangkalahatan program.” household survey, with 1,200 respondents among population sub-groups, the overall DOH has a computed share of Php nationwide, revealed that the law smoking prevalence in the country has 45.1 billion from the actual 2013 Sin Tax succeeded in reducing smoking prevalence not yet significantly decreased since the revenue collections which was allotted to among population sub-groups, particularly implementation of the Sin Tax law. One expansion of PhilHealth coverage to 14.7 M the youth and the poor. possible reason for this is the shift to less poor and near-poor Filipino families with The study showed that the expensive brands. Based on the survey, 45% subsidy from the national government from prevalence of smoking for those belonging of smoker switched to another brand of Php 12.5 billion in 2013 to Php 35.6 billion to Socio-Economic Class E or the very poor cigarettes when prices increased. in 2014. The remainder of funds would go to dropped from 38% in December 2012 to 25% Almost seven out of ten (67%) upgrading health facilities. in March 2014. Across age groups, smoking Filipino smokers buy cigarettes per stick,

32 HEALTHbeat I May - June 2014 In Memoriam Remembering Tony "If I die at age 50, I will have no regrets because I have lived a full life". Those were the words of my dear friend Anthony Roda, or Tony to everyone. Tony indeed lived a full life, in fact, a colorful one. He graduated Bachelor of Arts in Communication Arts and Master of Health Social Science from the De La Salle University. He was also the Editor-in-Chief of the official DOH publication HealthBeat, a creative writer/director of DOH health promotion materials in various formats, event organizer and campaign strategist for the DOH and other professional/non-government organizations, and one of the DOH tobacco control program coordinators and ASEAN focal points on tobacco control. During Tony’s illustrious career, he received several awards like the Gawad Oscar Florendo (GOF) Outstanding Public information Tool for HealthBeat on December 2003. According to its website, “The Gawad Oscar M. Florendo is a special awards program that reflects the genuine concern of the Public Relations Organization of the Philippines to recognize the outstanding public information programs and projects initiated by Philippine government institutions. Tony also bagged the 1996 GOF Gold prize for “Heroes For Health,” a video documentary on the Doctors to the Barrios program and “Volunteer of the Year” award in 1994 of the Remedios AIDS Foundation. Tony Roda, 50, during an anti-tobacco conference. Tony may appear suplado to some who do not know him personally, because of his seriousness in his work. His work is his His addiction to tobacco is an open secret among close passion. A proof of this is his one-man army effort in putting together friends, but ironically he worked so hard against tobacco addiction HealthBeat, from planning to lay-outing. including his own. His blog site against smoking was once closed by a Although staffwriters and contributors do their share, Tony known government official/politician. completes most of the Magazine's pages, especially the jokes sections. The closure of his blog did not stop him from disseminating He once told me that HealthBeat's readership grew tremendously information on the hazards of tobacco addiction because of his desire because of his jokes. (Bwahahaha . . .) Of course, HealthBeat is a very to save millions of lives. In fact, it only pushed him farther & harder to serious, informative reference magazine. concentrate more on his smoking advocacies. What I remember most about Tony? It was fun working Tony never stopped ranting about smoking. In fact, he was with him because he does not run out of creative ideas. To him, it was well-loved & respected among his peers in South East Asian countries. “work while you work, play while you play.” When not working or when work is done especially during

May - June 2014 I HEALTHbeat 33 regional training, Tony enjoys beer and singing, always of course with I’m so shocked and sad reading your email. Words seem inadequate to his supply of nicotine at hand. express the sadness I feel. As Michael said, Mr. Tony was such a great Tony died on April 7, the day when the world commemorated person, and very cooperative. He always promptly responded to our World Health Day. Just when everyone is raising the bar of querries. It was an honor to have known him. My deepest condolence consciousness on health, my friend never had the chance to regain for Mr. Tony’s family. his health. Tia So long, my friend, Godspeed. Kita kita na lng tyo jan soon. Tony Roda is one of the handful of tobacco control advocates Chill the beers. Fill your new world with laughter. Teach us again how who are always in the thick of things. to laugh, even without you. He was responsible for coming up and promoting the famous Of course, this page will not be complete without some slogan: “No Deal With the Tobacco Industry” which accompanied anecdotes or words of remembrances from some of Tony’s friends. the development of the Civil Service Commission and DOH’s Joint Here are some: Memorandum Circular (Protecting the Bureaucracy Against Tobacco Industry Interference). Advocates from different parts of the world have We are very sad and we offer our sincere condolences to the Health found this slogan impressive and have sought to adopt it. Promotion Division and to his family and close friends. May his soul rest No Deal with the Tobacco Industry. I would not have thought in peace. of saying something so direct but Tony, having struggled for decades WHO EPI Team with his cigarette addiction, knew just what to say to keep children from being lured into a lifelong addiction. My heart is broken and words can’t express my sorrow, he was such a Being a civil servant who served the public for most of his life, GREAT person and he will live on my memories forever. He was a GREAT Tony knew just the right message that would resonate with public officers AFPTC Focal Point from the Philippines and Chief Editor for E-Health who might be enticed by the tobacco industry’s misleading arguments or Bulletin. offers of “so-called corporate social responsibility” contributions. “Fake Michael Glen CSR!” as Tony passionately calls it. This is because he defines tobacco industry’s fake CSR as a contribution that is given at the expense of delayed, diluted, or ditched life-saving tobacco control policies. Atty. Deborah Sy

Words seem inadequate to express the sadness we feel by the loss of Mr. Tony Roda. He will remain in our hearts forever. Our thoughts and prayers are with Mr. Tony Roda’s family and DOH Philippines during this difficult time. ASEAN Secretariat

We are sincerely extending the most heartfelt condolences to the work family and personal family of Mr. Tony Roda. He has been very instrumental in the success of the tobacco control and communications initiatives in ASEAN.

I am deeply saddened with his passing. The ASEC family through the Health Division will make the necessary announcement to relevant ASEAN officials, especially the AFPTC. We will also make the necessary requiem section in future relevant communication publication. Dr. Fernando, MD, MDM Assistant Director/Head Health Communicable Diseases Division ASEAN Secretariat

34 HEALTHbeat I May - June 2014 We are very sad to know Mr. Tony Roda passed away. We will miss him forever. May he rest in peace. Our prayers and condolences. Bounlay Phommasack Tony Leachon, MD, FPCP, FACP Vice President, Philippine College of Physicians We are very sorry to hear that but he still remains in our heart forever. Khatthanaphone Condolences and Prayers. I feel sad to learn about his early demise;-( Dr. Ofelia Samar Sy It is regretted to hear this sad news and on behalf of MoH Cambodia, I would like to share our mourning and wish that his soul goes to peace and heaven. Many people could not understand the passion Tony had for Dr. Vandine, MoH Cambodia tobacco control because he was heavily addicted to the product. Surely, he couldn’t be completely trusted or the cynic would say this is nothing We are deeply sorry to hear about the death of Mr. Tony Roda. Please but a job for him, no more, no less. inform his family to accept our most heartfelt sympathies for this loss. I, on the other hand, understood him from the very beginning We will certainly miss him. because I had the same affliction for more than three decades before Dr. Bounpheng Philavong, MD, MPH, DrPH stopping. There is really no contradiction. One could even surmise that as Director of Centre for HIV/AIDS and STI one experienced the evils of tobacco addiction, one’s passion to prevent or Ministry of Health, Laos stop the epidemic from touching future generations only grew stronger. Tony Roda was one such person, dedicated and committed It is with a heavy and sad heart to let you all know our colleague Tony to the cause, ultimately offering himself as a grim reminder why we Roda from the DOH Philippines just passed away today (April 7). May should never relent in our efforts to eradicate this epidemic. he rest in peace. Atty. Alexander Padilla Bungon Ritthiphakdee President and Chief Executive Officer, PhilHealth

So sorry to hear this sad news. It is surely a big loss for AFPTC family. Farewell to dear friend and colleague, Tony. It has been great working I remember Mr. Toni Roda as a friendly gentleman. My thought and with you and it has been wonderful being friends with you. Thank you prayers go to him. May his soul rest in peace. for being a blessing to me and to many others whose lives you have Tiara Pakasi, Indonesia touched. You are sometimes misunderstood, but those who know you will profess you are undoubtedly a true friend and a good man. You left I am so sorry to hear this sad news. It is a big loss for AFPTC family! us at age 50, you rest in peace dear friend. Phan Thi Hai, Vice Director Dr. John Juliard Go VINACOSH Standing Office, Ministry of Health WHO Philippines

It’s really unexpected and sad to hear this sad news. It’s a lost to AFPTC Let us pray for his eternal repose, even as we strengthen our resolve to and more so for Tony’s loved ones. But this NCDs toll, we all need to work achieve a tobacco-free Philippines. harder to control NCDs. Tony’s passing away reminds us all to look after Ulysses Dorotheo, MD, FPAO our own health. May Tony rest in peace. Project Director, SEATCA Southeast AsiaTobacco Control Alliance Prof. Prakit Vathesatogkit, MD SITT Southeast Asia InitiativeOn Tobacco Tax Executive Secretary, Action on Smoking and Health Foundation, Thailand Am at a lost for words with the passing of a good friend and partner. On behalf of Thai team, we are really sorry for this huge lost, we hope we Have known Tony for many years (since 2005) primarily through his would work hard together to achieve our goal for him in both tobacco friends Nonong Mendoza, Au Banda, Luz Tagunicar. His premature control and other NCD problems. death will leave a void in DOH. Rest well dear friend and ally. You know Dr. Nopporn Cheanklin, MD, MPHM you joined your friend Nonong. I know that you are happy up there with Deputy Director General our loving Father. Department of Disease Control Dr. Maricar Limpin Ministry of Public Health, Thailand Executive Director, FACP

May - June 2014 I HEALTHbeat 35

The most inspiring thing that Tony told me is that “He is building Leaders, not Bosses”. He always gives credit to those who works hard. He has a very good eye for people who have potential to be a great leader. It is a big loss for me to lose a good mentor, how I wish I was able to complete my training under his supervision. Neil Bryan S. Hipolito, R.N. Health Program Officer I National Center for Health Promotion Department of Health

Without any free MMFF season pass from MMDA, Tony watched all the MMFF entries in 2011 and tracked the length of time each of the movies showed the smoking behavior on screen. His action led to the formulation of rules on the depiction of smoking in MMFF movie entries. Dr. Loida Alzona MMDA

Tony is survived by brother Cornelio and sister Dr. Margery Genabe and their respective families.

36 HEALTHbeat I May - June 2014 Women's Health DOH CELEBRATES BABAE MAHALAGA KA! Contributed by Karen Alparce-Villanueva Merck Sharp & Dohme (I.A.) Corporation

May brings to mind the Flores De programs have been established suchas National Center for Disease Prevention and Mayo, Santacruzan and Mother’s Day which the national guidelines for cervical cancer Control implemented VIA training to 56 local serve to honor the women who have been prevention and control, conduct of lay government units (LGUs) so that they may be the guiding light, the beacon of hope and forums on disease education and prevention able to provide the service to the women in the nurturer of families here and all over the and awareness campaigns. their communities. world. And so it happens that May is also In 2009, a national screening With the devolution of health, the Cervical Cancer Awareness Month for the program was piloted in 13 government provision of cervical cancer screening is a Department of Health (DOH) and it is only hospitals using the visual inspection with welcome development and institutionalizes fitting that we stop and ponder on how every acetic acid (VIA) method. this important intervention to be able to Filipino loves and cares for their mother,wife, The following year 2010, all 58 reduce the incidence of cervical cancer. sister, daughter, friend and for the women in government hospitals offered a 1-day free This year, 2014, the screening their lives. cervical screening during the month of May program will be expanded to include several Since 2008, the DOH partnered with to women 25 to 45 years old. The 1st National LGUs which have been trained for VIA namely global healthcare company MSD and the Symposium on Cervical Cancer Prevention Valenzuela, Paranaque, Makati, Marikina, country’s various medical societies such as and Control was also well-attended by the Albay and Surigao Del Sur. the Philippine Obstetrics and Gynecological different stakeholders in government. Cervical cancer is the 2nd most Society (POGS), the Society of Gynecologic In 2011, regional celebrations of common cancer in women worldwide. In Oncologists of the Philippines (SGOP), and cervical cancer awareness month were done the Philippines, 12 Filipino women die from the Philippine Society of Colposcopy and along with free weekly screening. cervical cancer each day. Cervical Pathology and other NGO groups Marking the 5th year of the It is caused by the human in an effort to raise awareness on cervical partnership, the screening program was papillomavirus (HPV) which is the most cancer and its prevention through screening, made more meaningful and practical as common sexually transmitted infection in vaccination, and healthy lifestyle. government hospitals offered the free both men and women. Aside from cervical Indeed, I have been a witness to this screening all month long, cryotherapy cancer, HPV can cause genital warts and PPP which is a coming together of kindred machines were donated to hospitals to allow cancers of the head, neck, and genital area. souls who wish to make a difference, albeit for single visit approach where treatment in Screening and vaccination can very simply and despite it being a long and the same facility is provided, and a multi- help prevent cervical cancer and other HPV- arduous task. stakeholder summit was conducted featuring related diseases. Dubbed Babae, Mahalaga local and international resource speakers to Bringing the advocacy of cervical Ka! (Woman, you are important!), the advance the cause of the advocacy program. cancer in the awareness of the public was not partnership first established the month of In 2013, the Degenerative Disease an easy task especially with the multitude of May as cervical cancer awareness month. Office (DDO) led by Dr. Bambi Caluag under concerns that the country is tackling. A public Over the years, policies and the leadership of Dr. Irma Asuncion of the information campaign and policy advocacy

May - June 2014 I HEALTHbeat 37 has been at the heart of the program. It was focused on prevention, early diagnosis against HPV 16/18. important to engage the media not only in and treatment. And so it was a welcome Recently, the EU and the Philippine the capital city but in the different key cities in development that the DOH National Center FDA approved the two-dose regimen of the the regions by conducting press conferences for Pharmaceutical Access and Management HPV vaccine for adolescents, because studies in the different partner hospitals. (NCPAM) has undertaken a Cost-Utility have shown that this is optimal because of Close coordination with the Analysis of Screening and HPV Vaccination. their robust immune system. technical working group composed of the The study concluded that the Since the program started, there offices of the DDO, the National Center strategy of expanding coverage of VIA are about 30,000 women between 25-45 for Health Promotion of the DOH, and the targeting 80% of adult women 35-45 years old being screened every year during officers of the medical societies were key to years old done at five-year intervals is the the month of May, most of them have never the success of the program. most efficient and cost-saving strategy to been screened since becoming sexually Each partner had an important implement in the Philippines. This has the active. role in the program – DOH was the main benefit of reducing cervical cancer cases and Cervical cancer awareness has body coordinating with all stakeholders; deaths by at least 25%. reached 99% in 2010 from a baseline of 40% the medical societies provided the technical Adding a vaccination program in 2008 when the program was started. expertise to conduct training, screening, and among 11-year old girls at a cost of Php Vaccination has yet to be included in lay fora; MSD provided the resources for the 2,400 per vaccinated child is potentially cost- the national immunization program but we educational materials and partnered with effective using the 1 GDP per capita threshold are hopeful that with a strong public-private media for the information campaign. in the Philippine setting. HPV vaccination partnership and with more stakeholders Aside from awareness, the program can further reduce cervical cancer burden by joining the advocacy, this will come in the brought together different stakeholders 50% with the most favourable assumption near future so that more women and young to advocate for a national policy that is that the vaccines provide lifelong immunity girls will be saved from cervical cancer.

KALAbeat A foolish man tells a woman to stop talking, but a wise man tells her that her mouth is extremely beautiful when her lips High heels were invented by a woman who had been are closed. kissed on the forehead. – By Christopher Morley Curve: The loveliest distance between two points I went on a diet in 2 weeks. I lost 14 days. Men and women are so different, but still can’t live without each other. They say i look good A woman opens beer bottles with a beer bottle opener. i say ... i taste even better!!! hehehehe!!! According to researches, an average woman spends about 120 hours a year looking at herself in the mirror, which is A jealous woman does better investigation than the NBI. approximately 5 entire days a year!

Give a girl the right shoes and she can conquer the world. Women love a bargain. – By Marilyn Monroe

38 HEALTHbeat I May - June 2014 Health Facilities 120 - bed OSPITAL NG PARAÑAQUE Inaugurated

Health Secretary Enrique T. Ona and Parañaque City Mayor facilities and equipment, plus another Php33 million for the city’s Edwin L. Olivarez recently led the formal opening and blessing of the various health centers. new 120-bed Ospital ng Parañaque. “This is God’s gift to us, and we must keep it in good shape so The city government spent Php200 million to build the six- that our people will fully benefit from the only public hospital in the storey hospital, which broke ground on August 31, 2013 – Mayor city,” the mayor said during the opening. Olivarez’ second month in office. Also in attendance were the city’s two congressmen, 1st Health Secretary Enrique Ona praised the city officials for District Rep. Eric L. Olivarez and 2nd District Rep. Gustavo Tambunting building the hospital which he likened to a private hospital when he who both said they will see to it that the budget promised by Secretary saw the quality of the construction and its facilities. Ona next year will materialize through their work in Congress. “Just one look and you can see that this is a very nice The new hospital is an addition to the existing 39-bed hospital,” Ona said. “Hopefully, the Ospital ng Parañaque will also be hospital which used to be called the Parañaque Community Hospital. able to provide high quality service to the people of Parañaque and It stands along Quirino Avenue, right across the Saint Andrew’s nearby areas similar to the services we see in private hospitals”. Cathedral in Barangay La Huerta. Aside from the hospital upgrade, the mayor said the city is The old hospital severely lacked medicines, supplies, and working to strengthen the health centers in the city’s 16 barangays to equipment. As the only public hospital in the city, it was always enable them to provide primary health care, including the provision congested. of lying-in maternity wards. Mayor Olivarez vowed to address the facility’s perennial The Department of Health through its Health Facility lack of medicines, supplies and modern equipment through regular Enhancement Program (HFEP) committed to provide at least Php20 appropriations. He also promised to add more trained personnel to million from the 2015 budget to further augment the new hospital’s ensure the delivery of efficient service to the public.

Pahinga Muna, Mag HEALTHbeat Online www.healthbeat.ph www.facebook.com/DOH.HEALTHbeat.ph

May - June 2014 I HEALTHbeat 39 Men's Health FREE MEN’S HEALTH CHECK IN DOH HOSPITALS FOR FATHERS’ DAY

It was the men’s turn. The program was conceptualized in order DRE centers all over the country with more to catch the attention of the Filipino male than a thousand patients examined and The Department of Health (DOH) population and to increase awareness on screened by urologist in a day. This year, recently conducted free digital rectal prostate diseases, particularly prostate activities included the distribution of posters, examinations (DRE) to males aged 40 years cancer. a Facebook poster and slogan contest, press and above in 27 DOH – retained hospitals Last year, there were already 64 conference, fun run, and technical updates. and 37 private hospitals in the country in conjunction with the worldwide celebration of Father’s Day dubbed as “National PaDRE and Men’s Health Day.” DRE is one of the main screening procedures in assessing the prostate. Most Filipinos are still uninformed about prostate cancer and a vast majority of cases are detected in the advanced stage. Screening among men is needed to detect the disease in its early stages. DOH records reveal that prostate cancer is now ranked as the 4th most common cancer among males. According to the 2010 Cancer Facts and Figures, about 2,712 new cases are diagnosed yearly in the Philippines with an estimated 1, 410 deaths. The incidence rate starts to increase sharply starting at age 55. “Advancing age is the most important risk and the number of Filipino males aged 40 years and older is the main reason for the significant increase and the expected continuing increase in cases,” Health Secretary Enrique Ona declared, adding that a substantial number of prostate cancer is very slow growing and may initially have no clinical impact. The national “PaDRE” program started in 1996 as a project of the DOH and the Philippine Urological Association (PUA).

40 HEALTHbeat I May - June 2014 Health Column Prostate cancer: The scourge of fathers By George Nava True II

Being a father isn’t easy. Raising a a tumor and invade healthy tissue or they may Both are recommended by the Philippine family and securing the future of your kids break off and spread throughout the body. Urological Association. is a big challenge for most dads. This huge The risk of getting prostate cancer In DRE, the doctor inserts a gloved, responsibility can affect their health and increases with old age. The usual victims are lubricated finger in the rectum to examine make them easy targets for a lot of diseases, men over 65. The chances of getting it also the prostate for changes in texture, shape including prostate cancer. increase if you have a family history of the or size. In the PSA test, the patient’s blood Worldwide, prostate cancer is the third disease or if the women in your family have is analysed for the presence of PSA that is most common cancer in men and the second breast cancer. Obesity is another risk factor as produced by the prostate gland. It’s normal most common cancer among Filipino males. well as being black. to have some PSA in the blood but high Local statistics aren’t available but in 2010, the In its advanced stage, prostate cancer levels may indicate prostate enlargement Department of Health said six million Filipino may cause the following symptoms: difficulty or cancer. men over 50 are susceptible to the disease. urinating, blood in the urine or semen, back, “PSA testing combined with DRE While the incidence of prostate hip or thigh pain, decreased force when helps identify prostate cancers at their cancer is lower in Asians compared to urinating, and erectile dysfunction. earliest stages, but studies haven't proved Caucasians, experts said this is still alarming As mentioned earlier, early that these tests save lives. For that reason, because Asian patients are often diagnosed detection of prostate cancer is the key to there is debate surrounding prostate cancer when the disease has already spread to other successful treatment. This is important since screening,” according to Mayo Clinic doctors. parts of the body. some types of prostate cancer may spread If the doctor discovers something The reason why prostate cancer quickly and result in complications. after conducting these two exams, he or is often ignored is because there are no When prostate cancer spreads or she may recommend more tests to confirm symptoms in the early stages of the disease. metastasizes, it can affect other organs like the whether the patient has prostate cancer. This type of cancer usually grows slowly and bladder and bones. At this stage, the disease These include a transrectal ultrasound and a is found initially in the prostate gland where may be controlled but it can’t be cured. prostate biopsy. it doesn’t cause any trouble. No wonder it’s Screening for prostate cancer remains The former uses a small, cigar- called the “silent killer of men.” controversial and medical organizations differ shaped probe inserted into the rectum to Located in front of the rectum, the in their recommendations. Some believe that take a picture of the prostate gland. In a prostate is a small, walnut-shaped gland screening healthy men with no symptoms prostate biopsy, the doctor uses a thin needle found between the bladder and the penis. It and no family history of the disease has no inserted into the prostate to take tissue produces a fluid that nourishes and protects benefits. Others said screening should be done samples. These samples are analysed in a lab sperm. During ejaculation, this fluid mixes by men in their 50s regardless of whether or for the presence of cancer cells. with sperm and is expelled as semen. not they have any symptoms. If cancer cells are found, imaging No one knows what causes prostate To detect prostate cancer, the tests may be required to see how far cancer but it starts when some cells become doctor may perform a digital rectal exam the cancer has spread. These include a abnormal. These abnormal cells may later form (DRE) or prostate-specific antigen (PSA) test. bone scan, ultrasound, computerized

May - June 2014 I HEALTHbeat 41 tomography scan and magnetic resonance Active surveillance may also be considered imaging. These tests will tell the doctor the for a man who has another serious health extent or stage of prostate cancer in the body. condition or an advanced age that makes TANONG: "Saang lugar parehong kulot cancer treatment more difficult,” it added. ang buhok ng babae at lalake?" The Mayo Clinic defines these stages as: Treatment options for prostate cancer include radiation therapy, hormone SAGOT: "Haha..! Gusto ko yang iniisip Stage I. This stage signifies very early cancer therapy, surgery to remove the prostate m0! Tama ka! Sa AFRICA!" :D that's confined to a small area of the prostate. (prostatectomy), ultrasound treatment, When viewed under a microscope, the cancer chemotherapy, and immunotherapy. cells aren't considered aggressive. To prevent prostate cancer, eat lots Stage II. Cancer at this stage may still be of fruits and vegetables. Stay away from Pedro: pare. may nakalimutan ako. small but may be considered aggressive high-fat foods. In this day of quick fixes and when cancer cells are viewed under the instant solutions, it’s easy to pop a vitamin Juan: anu un? microscope. Or cancer that is stage II may be pill in favor of real food. However, research larger and may have grown to involve both has shown that foods rich in vitamins and Pedro: bobo kba? nakalimutan ko nga eh! sides of the prostate gland. minerals are better than supplements. Stage III. The cancer has spread beyond Exercise is good for the prostate so the prostate to the seminal vesicles or other make it a habit to exercise daily to maintain nearby tissues. a healthy weight and reduce your risk of GIRL: :Kung talagang tayo, kahit san Stage IV. The cancer has grown to invade acquiring prostate cancer. There’s no need to sulok ng mundo magtatagpo tayo.” nearby organs, such as the bladder, or spread spend a fortune on gym membership to stay to lymph nodes, bones, lungs or other organs. fit. Many exercises like walking, jogging and BOY: “Never tayo magtatagpo. Walang aerobics can be done at home and won’t cost sulok ang mundo. Bilog ito bilog!” Treatment of prostate cancer you a cent. But don’t overdo it. Start slowly depends on the stage of the disease, how and increase your exercise routine gradually. fast it is spreading and the patient’s health. For those with a family history of Your doctor should tell you the risks and the disease, consider taking medications ROMY: "Waiter, bigyan mo nga ako ng benefits of each treatment so you can decide like 5-alpha reductase inhibitors, including isang tasang kape!" what is best for you. finasteride and dutasteride to reduce your Those with early stage prostate risk of getting prostate cancer. WAITER:"Yes sir, black coffee po ba?" cancer may not require any treatment and “However, some evidence indicates the doctor may observe the patient first. This that men taking these medications may have ROMY: "Bakit? May iba pa ba kayong is known as active surveillance. an increased risk of getting a more serious kulay?" “In active surveillance, regular form of prostate cancer (high-grade prostate follow-up blood tests, rectal exams and cancer). If you're concerned about your risk possibly biopsies may be performed to of developing prostate cancer, talk with your monitor progression of your cancer. If tests doctor,” the Mayo Clinic concluded. Isang daga (bubuwit) ang nakakita show your cancer is progressing, you may * * * ng paniki at buong pagmamalaki opt for a prostate cancer treatment such as National Press Club and Philippine Dental Association na nagkuwento sa kanyang nanay: surgery or radiation,” the Mayo Clinic said. awardee George Nava True II is the author of two "Mommy, mommy magiging santo bestsellers. He is a desk editor and health section “Active surveillance may be editor of The Manila Times. His popular column po ata ako, kasi nakakita ako ng an option for cancer that isn't causing “Health Frontiers” began in 1983 and has been carried anghel...." symptoms, is expected to grow very slowly by different newspapers. It currently appears in the and is confined to a small area of the prostate. leading Philippine tabloid Abante and every month at Healthbeat magazine.

42 HEALTHbeat I May - June 2014 ECTODERMAL DYSPLASIA: Hairless and Sweatless “Porke wala akong sweat glands, nasa SPED na?”

By Elizabeth G. Mascareñas, RN, MPH Staffwriter

Living with ectodermal dysplasia they affect less than 200,000 people. The membranes in the mouth and nose. HED is At 6 months, Jed Montevirgen was organization estimates that between 1 most commonly caused by an alteration in diagnosed with Ectodermal Dysplasia at the to 7 in 10,000 births in the US result in the ectodysplasin A gene, inherited on the University of the East Ramon Magsaysay ectodermal dysplasia. X-chromosome (XLHED). (UERM), his mother Missy revealed. Jed was Hypohidrotic Ectodermal Dysplasia Males with their single brought to the doctor because Missy noticed (HED) is a rare genetic disorder diagnosed on X-chromosome are fully affected by XLHED, that although his body felt so hot, he did not the basis of fine, sparse hair (hypotrichosis); while females inheriting one normal and perspire. Then at age 6, he was diagnosed few and often pointed teeth (hypodontia); one altered X-chromosome are variably with Attention Deficit Hyperactive Disorder and diminished or absent sweat function affected. XLHED is also known as Christ- (ADHD) at the Capitol Medical Center. (hypohidrosis). Siemens-Touraine syndrome. In the first years of life, XLHED- affected individuals are at risk for severe medical complications, most often associated with their inability to sweat, leading to hyperthermia, and their reduced mucous secretion predisposing them to respiratory infections. Through childhood, the focus of medical care for XLHED patients may shift to the chronic skin issues and severe hypodontia with its associated medical and self-esteem issues. The average adult tooth count in male patients affected with XLHED is only 6, and the few remaining teeth often are conical or peg-like. Dentures may be prescribed as early as age 2-3 yrs to enhance Jed with mother Missy and author. feeding and growth and to begin to address According to the US-based There are a number of secondary what are often life-long psychosocial issues. National Foundation for Ectodermal features of HED that may include a reduction While many families and doctors Dysplasia (NFED), ectodermal dysplasias in mucous glands in the pharynx, larynx, have found ways to manage their symptoms are a large and complex group of diseases, trachea and bronchi, dry eye symptoms, over the years, currently there are no specific and are considered rare conditions because eczema, asthma and dry mucous therapies for the treatment of XLHED. This

May - June 2014 I HEALTHbeat 43 disorder may not have specific treatment or all the time,” Missy relates. (ADHD), emotional/behavioral disorder, and cure, but this does not mean that children “My Jed really enjoys the company health impairments. with this disease cannot live a happy life. of his friends, they often visit him at our Republic Act 7277 or the Magna house and spend time with him. They never Carta for Disabled Persons (An Act Providing Ectodermal Dysplasia in treat Jed as a person with disability. They like for the Rehabilitation, Self-development and the eyes of a mother his company and I can say that they really Self-reliance of Disabled Persons and their Despite these conditions, Jed love my son,” Missy said. Integration into the Mainstream of Society went to a regular school in his hometown Jed often gets high scores in tests, and for Other Purposes), the government is in Marinduque from preschool up to the and that made his mother secure in the obliged to “encourage learning institutions 5th Grade because there was no school for knowledge that he is really doing good in to take into account the special needs of children with special needs like him. school. “Jed is a very sweet and thoughtful disabled persons with respect to the use of Missy recounts they had to transfer son, a loving brother to his siblings and a school facilities, class schedules, physical residence recently to Biñan, Laguna where God-fearing person. He will not eat his food education requirements and other pertinent she found work as a sales operations without praying, prays as soon as he wakes consideration. The State shall also promote manager in a real estate company. They also up and never goes to bed without praying,” the provision by learning institutions, of found a school offering Special Education his mother beams. auxiliary services that will facilitate the (SPED) classes. Jed is now independent, knows learning process for disabled persons.” Jed, then 12 years old, was hesitant how to control his anger and lives a normal And in compliance with the above at first to attend his SPED class. “He thought life; a life most parents want their children law, the Department of Education (DepEd) that he did not belong to that group and even to have. “And his school really helped me issued DECS Order No. 26, s. 1997, that says asked me one time why he needs to attend a in molding my son to what he has become “we shall endeavor to include a provision for SPED class. I explained to him his condition now,” Missy asserts. special education e.g. gifted and talented, and how his SPED class can help him live like Jed, at Grade 7, is studying at autism, ADHD to name a few.” a regular student”, Missy explained. the Panorama Montessori School of Biñan Jed’s school, the Panorama Eventually, he accepted the fact in Laguna. Under the Special Education Montessori School of Biñan, offers different that he had to attend SPED everyday and do Department (SPED), the school accepts programs for special children such as early the tasks that his teacher would ask him to children with autism spectrum disorder, intervention program which applies to do. Jed’s first days in school made his mother intellectual disability, learning disability, children of school age or younger who are at anxious as he would be exposed to a totally attention deficit hyperactive disorder risk of developing a handicapped condition new environment. There were new faces, new rules of behaving. All of it was really scary at first, even for her. She remembers frequently texting his teacher and his Principal just to make sure that Jed was doing fine and that he could stand the heat. Jed didn’t wear shoes in his previous school. Now he wears the complete set of uniform (undershirt, polo barong, long pants, socks and shoes). Missy said that wearing his uniform is a challenging task for Jed knowing that wearing socks could really heat up his body. But he seldom removes his socks and shoes in school now. “And he really did a great job! He just cools himself by having wet face towel and cold water ready Jed during one of his classes.

44 HEALTHbeat I May - June 2014 or other special needs that may affect their able to talk to teachers and classmates with Jed can now follow his teacher’s development and growth. The school’s early polite expressions (i.e. “Excuse me”, “Thank instructions without any hesitation. When childhood special education program focuses you”, “I’m sorry”, “Welcome”, “Please”, “Po”, asked, his teachers say that he is one very on the self help skills of children with special and “Opo”) with 60% accuracy measured by bright student but sometimes his laziness needs aged 3-7 years old and also prepares teacher/charted observation. The goal also gets in the way. There are times when he students for functional academics. intends to teach Jed to be able to use the would depend on his mother to do his Ms Racquel Matic-Asuncion, school appropriate polite expressions in settings homework or remind him when it is due. But principal, remembers when Jed first came to that call for it, and able to answer questions Jed is still dealing with this issue. Panorama Montessori School at 12 years old in a complete sentence. Jed still sometimes has tantrums and entered Grade 6. Jed was aloof and distant, Goal #3 deals with Jed’s social- and fits. But his friends know that when they behaviors that was quite challenging for his emotional growth. This teaches him to need his help, they can depend on him. He teachers. Jed sometimes acted like a child with participate in academic and non-academic acts like a big brother when he stays in the tantrums and fits. He also questioned the need activities to build his self confidence. Jed also SPED classroom. He always teaches Kim, (a for him to go to the SPED class. undergoes daily counseling on the events SPED classmate), gently the proper way to “Porke wala akong sweat glands, that took place in school and at home to act around other people. nasa SPED na?” Jed asked Missy at one time. encourage him to be open in expressing his Now, he is very open to the people With fine, sparse hair, no teeth, ideas and emotions. around him, especially his friends. He can and dry skin, Jed became distant and shy Goal #4 teaches Jed to comply with now converse with them even outside about mingling with other children. Jed the teacher’s instructions, both in regular the SPED classroom. He has learned the sees himself as different from other children, and special education. Meanwhile goal #5 importance of having peers to talk to and a difference that hinders his ability to excel encourages Jed to participate in sports and laugh with. He now listens to the advice in school. Ms. Asuncion said that controlling comply with the rules and regulations of the of his teachers regarding his behavior and anger, frustrations, and dealing with difficult game. actions. He may act like a child sometimes, people are the most crucial phase of Jed’s And goal #6 on nutrition will teach but when reprimanded, he does what is special education. him to develop a balanced diet that entails expected of his age. eating vegetables and fruits in school and to What does the future hold for a Individualized Education Plan tolerate different textures in food. child like Jed? Jed can be a computer wizard, Jed was provided with a highly as he is very much interested in information structured school environment, highly Present Level of Performance: March 2014 technology. He wants to develop a computer trained teachers, and an Individualized At the end of the school year, Jed software that will make him rich. He can be Education Plan that was charted and regularly was one of the students that have improved the next Mark Zuckerberg! monitored. Jed was identified as exceptional greatly since and was determined that he should be with he entered the inclusion program for grade 6. Inclusion this school. program means that Jed attends regular It was visible academic classes but has to extend one hour to everybody under the SPED department. who knew Jed’s individualized education plans him how he consist of different goals to achieve. Goal progressed #1 is cognitive in order for Jed to meet the and changed academic requirements needed in Grade 6 in a short with 70% accuracy and compliance measured span of time. by the teacher/charted observation. Goal #2 is communication wherein Jed, at the end of the school year, will be Jed with mother Missy, the author and SPED Department Officers.

May - June 2014 I HEALTHbeat 45 laughter HEALS 'Kakahayblad Ka Dugo Dugo Haba ng Hair Jet

DOK IVAN: Ano ang problema mo? ANAK: 'Tay, bakit po wala ng buhok MARIA: JET ka ba?” ED: Dok, gusto ko sanang si lolo?” JUAN: Bakit, dahil mabilis ako sa magpatingin sa inyo dahil TATAY: Anak, iyan ay tanda ng panliligaw sa yo? sa aking high blood. KARUNUNGAN! MARIA: Hindi. Kasi kapag dumadaan DOK IVAN: Bat mo naman nasabing ANAK: Ah kaya po pala ang kapal at ka, naiiwan ang GUHIT ng high blood ka? Eh, ang haba ng buhok nyo! amoy mo. Yuck!” payat-payat mo na nga at sa tingin ko'y wala ka na Hot Tea Bongga Ka, Girl yatang dugo! ED: Maniwala po kayo Dok. RUDOLF: Hot tea, please. Girl 1: Nandyan na yung sundo ko. Talaga pong sobra-sobra NICOLAS: Ako rin, hot tea. Make sure 'Yung limousine. Sabay ba ang dugo ko! malinis ang baso. kayo girls? DOK IVAN: Paanong nangyaring sumobra Pagkaraan ng dalawang minuto... Girl 2: 'Wag na, girl.. Pababa na ang 'yang dugo mo? WAITER: Order ninyo sir, dalawang hot tea. helicopter na sundo ko sa ED: Kasi Dok, suka ko dugo, Kanino na nga po 'yung malinis helipad. Ikaw, girl? tae ko dugo! ang baso? GIRL 3: Nandyan na rin naman ang sundo ko, eh. Congratulations! Soft drink o Tubig GIRL 1&2: Saan? GIRL 3: Hayun oh. Yung cute guy na DOK ERNIE: Congratulations! Sabihin mo GF: Kung isang inumin 'yang crush naglalakad na may dalang na sa asawa mo na buntis ka! mo, ano siya? flowers. Siya ang boyfriend ko. BAMBI: Wala po akong asawa... BF: Uhmmm, siguro soft drink. Single ako. GF: Ah... Eh ako? DOK ERNIE: Ah, sabihin mo nalang sa BF: (Ngumiti) Tubig! boyfriend mo na buntis ka. GF: Siya softdrinks, ako tubig lang? BAMBI: Wala po akong boyfriend. Wala ngang lasa ang tubig eh! DOK ERNIE: Ganun ba? Ganito nalang... Mas mahal mo yata siya kesa Sabihin mo sa mga magulang sa akin ,eh! mo na magdasal... dahil Ikaw BF: Hindi sa ganun. Kasi ang soft na ang susunod na Virgin Mary. drinks minsan mo lang dapat iniinom kasi hindi healthy. Bestfriend 'Tsaka mabubuhay naman ako na wala 'yun. Eh ang tubig, BO: Condoms are like bestfriends. araw-araw ko kailangan at ALVIN: Ha? Bakit mo naman nasabi 'yan? higit sa lahat, isa 'yun sa mga BO: They're always there to protect importanteng bagay na you when it gets hard. ikabubuhay ko. Parang IKAW.

46 HEALTHbeat I May - June 2014 Health Online Health and Social Media in the Philippines by Dennis B. Magat HEALTHbeat Staff The influence of social media to Filipinos industry and the government with respect to achievements. It is also known as the Business knows no boundaries. Pre-school children, Internet usage. They reasoned out that they Facebook where companies and individuals students, professionals, and even grandmothers, want to increase the competitiveness of the use the network to meet and look up are into computer these days. According to the country's internet speed and access to boost information about the people and companies Internet World Stats, the Philippines is the 6th top productivity and to spur economic growth they are about to engage with. Google+ gets internet users in Asia today. through business process outsourcing (BPOs) everyone to see what you are up to. From an estimated 2013 population and small and medium scale enterprises Undoubtedly, Facebook is the most of 92.3 million, 33.6 million Filipinos are active (SMEs), particularly online-based enterprises. (750M users) popular social networking site, internet users. This is translated to about 3.5 Filipino web users are more likely followed by Twitter (250M users), LinkedIn out of 10 Filipinos are online at any given time. to visit a social networking site (17%), (110M users), Pinterest (85.5M users), and Most (40%) of the these online population multimedia site (5%) entertainment site MySpace (70.5M users). belong to the 15-24 years old, followed by (5%), photo sharing site (3%), search engine The primary use of social media is the 25-34 years age group (31%), 35-44 years site (3%) and gaming site (1%). to socially interact online via content-sharing, (16%), and 45-54 years (9%). In 2011, 24/7 Wall Street research collaboration, and updating. However, do Filipinos In Southeast Asia, the Philippines showed the Philippines as the country with also use social media for their health concerns? had the fastest growth rate in internet the highest (93.9%) Facebook penetration. Social media has been found to audience at 22%, and also the fastest growth The Philippines is followed by Israel (91%), potentially influence people’s decision on their recorded in search engine usage at 19%. Turkey (90.9%), Chile (90.2%), and Argentina health. A study compiled by Demi and Cooper The average Filipino spends 16.4 hours on (89.2%). The country is also the 8th most Advertising and DC Interactive Group showed the internet per month. About 41.5% of the popular country in Twitter. that more than 90% of people ages 18-24 total internet time is spent on social media, There are countless social media In said they would trust health information they 17.3% on services, and 14.5% on news and the internet today. Some of these are Twitter, found on social media channels. information. Also, about 40% of Filipino Facebook, FourSquare, Quora, YouTube, Also, a PwC Health Research Institute smartphone owners browse the internet LinkedIN, and Google+. survey showed that 40% said they have used using their mobile device. Twitter is a microblog and users social media sites to find health-related consumer Ironically, at least 80% of prepaid, usually tell their followers what has popped reviews like treatment or physicians, one in every postpaid and business subscribers of up in their heads. Facebook tells everyone three internet users used YouTube, Facebook, and telecommunications companies want what he/she did. FourSquare tells everyone Twitter to find medical information, research, and cheaper, faster, more accessible, and reliable where they did it based on their location. share their symptoms, and offer opinions about internet connection at the guaranteed Quora, on the other hand, asks everyone a doctors, treatments, drugs, and health plans, and minimum speed as stated in the purchased question to get collective answers. one in every four have posted about their health package at the cheapest possible rate. YouTube broadcasts your claim to experience. Subscribers want greater fame and being a TV producer for everyone According to the study, 45% transparency from the telecommunications to see. LinkedIN tells everyone about your of respondents said health information

May - June 2014 I HEALTHbeat 47 obtained from social media sites would 2. provide answers to medical questions 12. currently, health professionals may not cause them to seek a second opinion, 41% 3. facilitate dialogue between patients, or often use social media to communicate said social media sites would influence their between patients and health to patients choice of a specific physician, hospital, or 4. professionals medical facility, more than 40% said health 5. collect data on patient experiences and The era of the internet is on us now, information on social media sites would opinions despite the Philippines having one of the affect how they manage a chronic condition 6. health intervention, health promotion slowest internet connections in Asia. It has its or any diet and exercise routines, while 34% or education pros and cons. What works for one may not said social media sites would affect their 7. reduce stigma also prove effective for his neighbor. Dr. Lee decision to take certain medications. 8. professional online consultation Suy suggests that if time permits, one should With this development, health always go for actual physical examination for professionals are also joining the bandwagon. The benefits of social media are the following: precise management of cases. Many doctors now are becoming social 1. increased interaction with others media savvy. 2. more available, shared and tailored References: A 2013 Digital Doctor Survey information http://www.internetworldstats.com/stats3.htm#asia conducted by ZocDoc, a service that helps 3. increased accessibility and widening http://www.forward.ph/blog/the-state-of-philippine- patients receive faster access to care and access internet-usage-2013-infographic/ optimizes doctors' schedules in the USA, 4. peer/social/emotional support http://www.change.org/petitions/we-want-cheaper- revealed that tech-savvy physicians are 5. public health surveillance faster-more-accessible-and-reliable-phinternet? largely embracing changing healthcare 6. potential to influence health policy recruiter=48896642&utm_campaign=twitter_ link_action_box&utm_medium=twitter&utm_ technology trends. The said survey further source=share_petition revealed that 83% of physicians have a Despite the benefits mentioned http://247wallst.com/technology-3/2011/05/09/the- website dedicated to their practice, 74% above, the limitations outweighed the ten-nations-where-facebook-rules-the-internet/3/ use a practice management system in their benefits. http://www.philstar.com/ office, 63% allow patients to fill out medical opinion/2014/01/12/1277870/we-people/ forms online ahead of time, and 62% have The limitations of social media include: philippines-belongs-asian-century sent prescriptions to a patient electronically. 1. lack of reliability http://www.noypi.ph/index.php/technology/4023- Current Department of Health 2. quality concerns philippines-from-being-the-text-capital-is-now-the- social- Spokesperson Dr. Lyndon Lee Suy does not 3. lack of confidentiality and privacy http://thetechieguy.com/2011/10/10/how-to-explain- go for that kind of practice. He added that 4. often unaware of the risks of disclosing social-media-its-all-about-the-pee/ there are things better seen by the health personal information online http://www.forward.ph/blog/top-10-most-popular- worker through actual physical examination 5. risks associated with communicating social-networks-2013/ than by description alone using the internet. harmful or incorrect advice http://mashable.com/2012/12/18/social-media- Consultation without actual assessment of the 6. information overload mobile-healthcare/ patient has its limitations and is unreliable. 7. not sure how to correctly apply http://pwchealth.com/cgi-local/hregister.cgi/reg/ In 2013, Moorhead et al conducted information found online to their health-care-social-media-report.pdf a systematic review to find out how people personal health situation http://circ.ahajournals.org/content/127/17/1829.full. use social media for health communication 8. certain media technologies may be html?ijkey=oVn9Ue8CdlZbUAA&keytype=ref and what benefits and/or limitations have more effective in behavior change than http://hcsmmonitor.com/2013/12/20/how-did- been reported. others doctors-use-social-media-in-2013/ 9. adverse health consequences http://www.ncbi.nlm.nih.gov/pmc/articles/ The reasons for using social media for health 10. negative health behaviors PMC3636326/ communication were as follows: 11. social media may act as a deterrent http://www.thelifestyleelf.net/social-media-in- health-care-benefits-harms-and-the-need-for-good- 1. provide health information on a range for patients from visiting health quality-evidence/ of conditions professionals

48 HEALTHbeat I May - June 2014 Child Health Feed the Children in Malabon and Manila by Glen S. Ramos Staffwriter

On September last year, the Department of Health – National Capital Regional Office (DOH-NCRO) started its community feeding program in Barangay Catmon in Malabon City having registered a prevalence rate of 4.92% of combined underweight (3.79% or 1,857 cases) and severely underweight (1.13% or 556 cases) among preschoolers aged six years old and below. A more alarming data on stunting showed a 12.91% (3,750 cases) and severe stunting at 6.31% (1,832 cases) based on the Operation Timbang (OPT) result of 2012. A validation on the 2013 OPT result showed that Barangay Catmon still topped the list in the prevalence of stunting and severe stunting at 36.06% with 1,171 cases. Wasting and severe wasting prevalence is at 6.8% affecting 221 children, underweight and severe underweight at 5.3% with 172 cases. Because of this alarming situation, then DOH-NCRO Director Eduardo C. Janairo, immediately coordinated with the local government officials, health workers and parents of children and implemented the Community Feeding Project for the wasted and severely wasted children on October 7, 2013 to January 2014. The program lasted for 90 days. A total of 221 targeted children were given free sustenance. Out of the 221 children in Barangay Catmon, 5 children (2.26%) went from severe A beneficiary of the feeding program.

May - June 2014 I HEALTHbeat 49 The OPT 2012 identified 10,404 severely underweight and 33,699 underweight preschoolers at the National Capital Region using the weight of age as basis. Results of the OPT 2012 among the LGUs with the most number of combined severely and underweight children were San Juan at 6%, Malabon at 4.92%, Pasay – 3.93%, Navotas – 3.69%, Pasig – 3.68%, Manila – 3.67%, Las Pinas - 3.23%, Pateros – 3.0%, Valenzuela – 2.66%, Paranaque – 2.64%, Muntinlupa – 2.59%, Caloocan – 2.15%, Taguig – 2.05%, Quezon City – 1.87%, Mandaluyong- 1.27%, Marikina – 0.96% and Makati with 0.91%. DOH Undersecretary Teodoro Herbosa shares a light moment with Malabon City Health Officer Dr. Rommel Lizan, then DOH-NCRO Director Three cities, namely Quezon, Eduardo Janairo and Dr. Ruben Siapno, DOH-NCRO Assistant Regional Director during the final activity of the community feeding program. Caloocan and Manila, registered the underweight to normal, 54 children (24.43%) were a total of total of 190 identified children most number of severely underweight from underweight to normal, 7 children in the Smokey Mountain District. preschoolers in 2012. However, there are (3.17%) from severe wasted to normal, 29 Out of the 190 children in the already on-going feeding activities being children (13.12%) from wasted to normal and Smokey Mountain district, 10 children (5.26%) sponsored by the local government and 43 was sustained in height for age. went from severe underweight to normal, non-government organizations. In the city of According to Director Janairo, the 58 children (30.53%) from underweight to Manila, feeding programs in selected areas objective of the feeding program is to improve normal and 27 children (14.21%) from severe are being undertaken in day care centers by the nutritional well-being of the identified underweight to underweight. the local social welfare office. wasted and severely wasted children in the During the End Program of the According to the United Nations community. “This is to ensure that adequate Community Feeding Project on May 29, Children's Fund, malnutrition is defined as food with vitamins and nutrients is given to and 2014, Undersecretary Teodoro J. Herbosa under nutrition resulting to insufficient food consumed by the children. Proper nutrition is reported most of the preschool children intake and repeated infectious diseases. It effective in preventing growth failure, provides under the feeding project gained reasonable includes being underweight for one’s age, protection against diarrheal diseases, stimulates weight and sustained their nourishment. He too short for one’s age (stunted), dangerously child mental and ensure physical growth & assured that the project will be continued in thin for one’s height (wasted) and deficient development growth,” he stated. other areas of Metro Manila to help address in vitamins and minerals (micronutrient He also added that the feeding the single biggest cause of disease which is malnutrition). program is likewise meant to keep them malnutrition. healthy and strong in preparation for the “Most of the undernourished opening of classes on June. children in Metro Manila are preschool- Also included among the targeted aged children and can be found in low and areas of the community feeding program middle-income classes. We need to protect were Barangays 128, 129, 130 and 133 in these children by providing them the proper the Smokey Mountain in the City of Manila. nutrition so that we can prevent the risk These were the areas that registered the of a long-term functional impairment, most number of under nutrition among such as poor educational and intellectual children in the region as validated by the performance,” Undersecretary Teodoro J. 2012 Operation Timbang (OPT 2012). There Herbosa declared.

50 HEALTHbeat I May - June 2014 SAbeat Pasukan Na! Quiz Flappy Bird Problem Solving

1. Trulalu GURO: Class, narito ang dalawang GURO: Who can solve this problem? 2. Eklavu ibon: isang pipit ant isang maya. (At sinulat sa blackboard ang 3. Eklavu Maaari n'yo bang ituro sa akin 3x5- 4x9/10 x6=?) 4. Trulalu ... kung alin dito ang pipit? CLASS: (Walang imik lahat) - Isang batang bakla na JUNJUN: Ma'am, 'yung pong pipit ay GURO : Lizelle, go to the blackboard sumasagot sa quiz na katabi po ng maya! and solve the problem . . . True or False LIZELLE: (Tumayo at pumunta sa Wow, Heavy! unahan. Kinuha ang eraser Get Here at binura lahat...) 'Yan Ma’am, GURO: Ang tawag sa maliit na hipon ay your problem is solved! GURO: You're late. How did you get here? hibi. CLASS: (Nagpalakpakan!) Did you ride or did you walk? CLARITO: Ma'am, bakit po hibi eh magaan EDGAR: Of course, did you ride! What do lang naman yun? DisKurso! you think of me, did you walk? Diabetes INAY: Anak, ano ang kursong gusto Sakay Na! mong kunin sa college? GURO: Prescy, kapag may 100 candies JIMBO: Political Science po para linisin GURO: Bakit hindi ka nagsusulat? ako at kinain ko ang 95, meron ang kalat sa lipunan! CHRIS: Ma'am wala po akong bolpen! na lang akong ano? INAY: 'Yung kalat mo sa bahay 'di mo GURO: Na naman? Paano ka nakaka- PRESCY: Meron po kayong taglay na malinis, sa lipunan pa kaya?!? pasok ng walang bolpen? kadamutan at ikamamatay mo CHRIS: Sumasakay po ng jeep! 'yan ng diabetes! Tamad

Always Late Bawal Matulog NOEL: Araw-araw ako sinasabihan sa bahay na TAMAD kaya araw- INAY: Sabi ng titser mo lagi kang late? GURO: Bawal kayong matulog dito sa araw din akong nagpaplanong JENNY: Kasalanan po ng iskul! classroom dahil hindi ito bahay. maglayas! INAY: Bakit? EDNA: Eh 'di bawal din mag-aral sa EDWIN: Bakit hindi natutuloy? JENNY: Lagi nilang pinapatunog ang bahay, Ma'am, dahil hindi 'yun NOEL: Tinatamad ako! bell bago ako dumating! classroom Salbahe No ID, No Entry Hoy, Gising! GURO: Misis, pinatawag kita dahil GUARD: ID mo? GURO: Class, gisingin n'yo 'yang ang salbahe ni Kristal. CHIT: Eto oh. natutulog sa likuran habang pagkagaling ng bakasyon! GUARD: I-pin mo. nagtuturo ako dito! LUZ: Aba Ma'am, dalawang buwan CHIT: (Ngumanga) Hirap naman dito, AILEEN: Eh mam, kayo po nagpatulog, salbahe 'yan sa bahay pero hindi pati ipin tinitingnan! dapat kayo din po manggising! kita pinatawag!

May - June 2014 I HEALTHbeat 51 52 HEALTHbeat I May - June 2014